| Old Corner Wellness Inc | |
|
200 N Main St West TX 76691-1207 | |
| (254) 826-5122 | |
| Not Available |
| Full Name | Old Corner Wellness Inc |
|---|---|
| Speciality | Nurse Practitioner |
| Location | 200 N Main St, West, Texas |
| Authorized Official Name and Position | Randy James Niemeyer (OWNER) |
| Authorized Official Contact | 2548265122 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Old Corner Wellness Inc 200 N Main St West TX 76691-1207 Ph: () - | Old Corner Wellness Inc 200 N Main St West TX 76691-1207 Ph: (254) 826-5122 |
| NPI Number | 1003514597 |
|---|---|
| Provider Enumeration Date | 02/23/2023 |
| Last Update Date | 06/04/2024 |
| Medicare PECOS PAC ID | 3577921105 |
|---|---|
| Medicare Enrollment ID | O20230614000991 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1003514597 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | (* (Not Available)) | Secondary |
| 363LA2200X | Nurse Practitioner - Adult Health | (* (Not Available)) | Primary |
| Provider Name | Lorrie Smith |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1922402056 PECOS PAC ID: 0547585291 Enrollment ID: I20150220001989 |
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