| |
110 N Main Box 391 Palmer TX 75152-9538 | |
(972) 449-3555 | |
(972) 449-3344 |
Full Name | |
---|---|
Speciality | Internal Medicine |
Location | 110 N Main Box 391, Palmer, Texas |
Authorized Official Name and Position | Enola Nelson (CEO) |
Authorized Official Contact | 9724493555 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
---|---|
110 N Main St P.o. Box 391 Palmer TX 75152-9538 Ph: (972) 449-3555 | 110 N Main Box 391 Palmer TX 75152-9538 Ph: (972) 449-3555 |
NPI Number | 1366769408 |
---|---|
Provider Enumeration Date | 04/29/2010 |
Last Update Date | 10/27/2010 |
Medicare PECOS PAC ID | 2163483272 |
---|---|
Medicare Enrollment ID | O20101027000895 |
Identifier | Type | State | Issuer |
---|---|---|---|
1366769408 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207R00000X | Internal Medicine | F0194 (Texas) | Primary |