Moulton Clinic | |
100 S Pecan Moulton TX 77975-0238 | |
(361) 594-3824 | |
Not Available |
Full Name | Moulton Clinic |
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Speciality | Clinic/Center |
Location | 100 S Pecan, Moulton, Texas |
Authorized Official Name and Position | Ralph Wagner (MD) |
Authorized Official Contact | 3615943824 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Moulton Clinic Po Box 965 Shiner TX 77984-0965 Ph: (361) 594-3824 | Moulton Clinic 100 S Pecan Moulton TX 77975-0238 Ph: (361) 594-3824 |
NPI Number | 1356322127 |
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Provider Enumeration Date | 11/09/2005 |
Last Update Date | 11/02/2017 |
Medicare PECOS PAC ID | 9335108091 |
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Medicare Enrollment ID | O20041007000509 |
Identifier | Type | State | Issuer |
---|---|---|---|
1356322127 | NPI | - | NPPES |
063662301 | Medicaid | TX |
Taxonomy | Type | License (State) | Status |
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261QR1300X | Clinic/center - Rural Health | (* (Not Available)) | Primary |
363A00000X | Physician Assistant | PA11615 (* (Not Available)) | Secondary |