| |
561 State Street Jasper TX 75951-5134 | |
(409) 384-8990 | |
(409) 384-9921 |
Full Name | |
---|---|
Speciality | Clinic/center - Rural Health |
Location | 561 State Street, Jasper, Texas |
Authorized Official Name and Position | Brad Thibodaux (CHIEF DATA OFFICER) |
Authorized Official Contact | 4093848990 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
---|---|
561 State St Jasper TX 75951-5134 Ph: (409) 384-8990 | 561 State Street Jasper TX 75951-5134 Ph: (409) 384-8990 |
NPI Number | 1649462482 |
---|---|
Provider Enumeration Date | 08/15/2007 |
Last Update Date | 01/28/2014 |
Identifier | Type | State | Issuer |
---|---|---|---|
1649462482 | NPI | - | NPPES |
PA02232 | Other | TX | PA LICENCE |
571660 | Other | TX | NURSES LICENCES |
742386 | Other | TX | NURSES LICENSE |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261Q00000X | Clinic/center | G3189 (Texas) | Secondary |
261QR1300X | Clinic/center - Rural Health | G3189 (Texas) | Primary |
Christus Jasper Memorial Hospital Family Practice Center - Jasper Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 1276 S Peachtree St, Jasper, TX 75951 Phone: 361-887-9083 | |
Emd Health Centers Inc. Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 203b S Main St, Jasper, TX 75951 Phone: 409-224-8289 | |