| |
55 S Fm 2353 Ste A Graford TX 76449-3251 | |
(940) 664-2169 | |
(940) 664-2173 |
Full Name | |
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Speciality | Clinic/Center |
Location | 55 S Fm 2353 Ste A, Graford, Texas |
Authorized Official Name and Position | William Whiddon (CFO) |
Authorized Official Contact | 9403286401 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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400 Sw 25th Ave Mineral Wells TX 76067-8246 Ph: (940) 328-6422 | 55 S Fm 2353 Ste A Graford TX 76449-3251 Ph: (940) 664-2169 |
NPI Number | 1477121150 |
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Provider Enumeration Date | 06/17/2021 |
Last Update Date | 03/29/2022 |
Medicare PECOS PAC ID | 5890602759 |
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Medicare Enrollment ID | O20220323002440 |
Identifier | Type | State | Issuer |
---|---|---|---|
1477121150 | NPI | - | NPPES |
45D2245488 | Other | TX | CLIA |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QR1300X | Clinic/center - Rural Health | (* (Not Available)) | Primary |