Pca Greenville | |
4400 Ih 30 W Suite 100 Greenville TX 75402-4620 | |
(469) 800-3524 | |
(469) 800-3564 |
Full Name | Pca Greenville |
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Speciality | Clinic/Center |
Location | 4400 Ih 30 W, Greenville, Texas |
Authorized Official Name and Position | Jessica Harding (OPERATIONS MANAGER) |
Authorized Official Contact | 4698008500 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Pca Greenville 8080 N Central Expy Ste 600 Dallas TX 75206-3794 Ph: (469) 800-8649 | Pca Greenville 4400 Ih 30 W Suite 100 Greenville TX 75402-4620 Ph: (469) 800-3524 |
NPI Number | 1790723468 |
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Provider Enumeration Date | 06/03/2006 |
Last Update Date | 06/07/2022 |
Medicare PECOS PAC ID | 3971568023 |
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Medicare Enrollment ID | O20041130000881 |
Identifier | Type | State | Issuer |
---|---|---|---|
1790723468 | NPI | - | NPPES |
00J629 | Other | TX | BCBS GROUP |
137940607 | Medicaid | TX | |
091888002 | Medicaid | TX | |
137940601 | Medicaid | TX |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QR1300X | Clinic/center - Rural Health | (* (Not Available)) | Primary |
Provider Name | Robert F Deuell |
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Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1407894959 PECOS PAC ID: 4688626120 Enrollment ID: I20050214000248 |
Provider Name | Terry L Sadler |
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Provider Type | Practitioner - Physical Therapist In Private Practice |
Provider Identifiers | NPI Number: 1376658609 PECOS PAC ID: 6002869492 Enrollment ID: I20050225000147 |
Provider Name | Clifford T Scott |
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Provider Type | Practitioner - Pediatric Medicine |
Provider Identifiers | NPI Number: 1669485645 PECOS PAC ID: 3870548779 Enrollment ID: I20050314000722 |
Provider Name | Elham Ziai-jamalabadi |
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Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1568433027 PECOS PAC ID: 6002818853 Enrollment ID: I20070207000150 |
Provider Name | Linda Ball |
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Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1215953666 PECOS PAC ID: 7113024753 Enrollment ID: I20070516000415 |
Provider Name | Joshua K Trussell |
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Provider Type | Practitioner - General Surgery |
Provider Identifiers | NPI Number: 1760684195 PECOS PAC ID: 5395897995 Enrollment ID: I20090713000320 |
Provider Name | George Clark |
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Provider Type | Practitioner - Pediatric Medicine |
Provider Identifiers | NPI Number: 1992733802 PECOS PAC ID: 1850457227 Enrollment ID: I20100830000126 |
Provider Name | Martin Cutrell |
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Provider Type | Practitioner - Pediatric Medicine |
Provider Identifiers | NPI Number: 1801809918 PECOS PAC ID: 2769548130 Enrollment ID: I20101201000803 |
Provider Name | Kimberly H Wagner |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1164691465 PECOS PAC ID: 0941480271 Enrollment ID: I20110203000690 |
Provider Name | Joshua Hamilton |
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Provider Type | Practitioner - General Surgery |
Provider Identifiers | NPI Number: 1487850582 PECOS PAC ID: 3375708142 Enrollment ID: I20120628000323 |
Provider Name | Sherri D Bridges |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1982975827 PECOS PAC ID: 4284877283 Enrollment ID: I20130823000141 |
Provider Name | Andrew Standerwick |
---|---|
Provider Type | Practitioner - General Surgery |
Provider Identifiers | NPI Number: 1598961898 PECOS PAC ID: 1557527991 Enrollment ID: I20131029001454 |
Provider Name | Harold A Barnard |
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Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1710074612 PECOS PAC ID: 3173512340 Enrollment ID: I20131107001329 |
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