| Nacogdoches Internal Medicine Pllc | |
|
412 North St Ste E Nacogdoches TX 75961 | |
| (936) 560-1812 | |
| (936) 560-3070 |
| Full Name | Nacogdoches Internal Medicine Pllc |
|---|---|
| Speciality | Internal Medicine |
| Location | 412 North St Ste E, Nacogdoches, Texas |
| Authorized Official Name and Position | Walter Brad Wilson (PRESIDENT) |
| Authorized Official Contact | 9365601812 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Nacogdoches Internal Medicine Pllc 412 North St Ste E Nacogdoches TX 75961-5070 Ph: (936) 560-1812 | Nacogdoches Internal Medicine Pllc 412 North St Ste E Nacogdoches TX 75961 Ph: (936) 560-1812 |
| NPI Number | 1609319458 |
|---|---|
| Provider Enumeration Date | 11/28/2016 |
| Last Update Date | 05/21/2018 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1609319458 | NPI | - | NPPES |
| 377530601 | Medicaid | TX | |
| 113906502 | Medicaid | TX |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | H3293 (Texas) | Primary |
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