| Full Name | |
|---|---|
| Speciality | Family Medicine |
| Location | 200 E 2nd St, Nixon, Texas |
| Authorized Official Name and Position | David Keefauver (MANAGING PARTNER) |
| Authorized Official Contact | 3612752381 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
200 E 2nd St Nixon TX 78140-2737 Ph: (830) 582-1222 | 200 E 2nd St Nixon TX 78140-2737 Ph: (830) 582-1222 |
| NPI Number | 1285713222 |
|---|---|
| Provider Enumeration Date | 11/02/2006 |
| Last Update Date | 08/31/2009 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1285713222 | NPI | - | NPPES |
| 170895005 | Medicaid | TX | |
| 170895004 | Medicaid | TX | |
| 0032LZ | Other | TX | BCBS |
| 170895003 | Medicaid | TX |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |