| Occupational And Family Medicine Of South Texas | |
|
4001 Preston Ave Suite 110 Pasadena TX 77505-2019 | |
| (281) 249-2273 | |
| (281) 249-2123 |
| Full Name | Occupational And Family Medicine Of South Texas |
|---|---|
| Speciality | Family Medicine |
| Location | 4001 Preston Ave, Pasadena, Texas |
| Authorized Official Name and Position | Todd Allen Evans (VICE PRESIDENT) |
| Authorized Official Contact | 7133839605 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Occupational And Family Medicine Of South Texas 4001 Preston Ave Suite 110 Pasadena TX 77505 Ph: (281) 249-2273 | Occupational And Family Medicine Of South Texas 4001 Preston Ave Suite 110 Pasadena TX 77505-2019 Ph: (281) 249-2273 |
| NPI Number | 1780639138 |
|---|---|
| Provider Enumeration Date | 05/24/2006 |
| Last Update Date | 04/15/2011 |
| Medicare PECOS PAC ID | 1456362185 |
|---|---|
| Medicare Enrollment ID | O20060509001050 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1780639138 | NPI | - | NPPES |
| 181947601 | Medicaid | TX |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| 332B00000X | Durable Medical Equipment & Medical Supplies | (* (Not Available)) | Secondary |
| Provider Name | John D Kirkwood |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1073598777 PECOS PAC ID: 0547153165 Enrollment ID: I20040205001321 |
| Provider Name | Robin A Watson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1508820507 PECOS PAC ID: 2961397807 Enrollment ID: I20040218001055 |
| Provider Name | Frank J Ponce |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1497956734 PECOS PAC ID: 3678629409 Enrollment ID: I20090921000447 |
| Provider Name | Toby C Kirkwood |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1750541991 PECOS PAC ID: 4789868365 Enrollment ID: I20110405001080 |
| Provider Name | Araceli Hernandez |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1326426198 PECOS PAC ID: 7012224702 Enrollment ID: I20150912000248 |
| Provider Name | Beau Kirkwood |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1811557333 PECOS PAC ID: 3375879257 Enrollment ID: I20221110001601 |
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