Primary Care Of Eagle Pass Pllc | |
1975 N Veterans Blvd Ste 9 Eagle Pass TX 78852-4456 | |
(830) 213-8186 | |
(830) 213-8157 |
Full Name | Primary Care Of Eagle Pass Pllc |
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Speciality | Family Medicine |
Location | 1975 N Veterans Blvd Ste 9, Eagle Pass, Texas |
Authorized Official Name and Position | David W Chisum (SOLE MEMBER) |
Authorized Official Contact | 8302138186 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
---|---|
Primary Care Of Eagle Pass Pllc 1975 N Veterans Blvd Ste 9 Eagle Pass TX 78852-4456 Ph: (830) 213-8186 | Primary Care Of Eagle Pass Pllc 1975 N Veterans Blvd Ste 9 Eagle Pass TX 78852-4456 Ph: (830) 213-8186 |
NPI Number | 1043901788 |
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Provider Enumeration Date | 05/15/2023 |
Last Update Date | 09/26/2023 |
Medicare PECOS PAC ID | 8123485653 |
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Medicare Enrollment ID | O20230526002616 |
Identifier | Type | State | Issuer |
---|---|---|---|
1043901788 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207Q00000X | Family Medicine | (* (Not Available)) | Primary |
Provider Name | David Westly Chisum |
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Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1417586991 PECOS PAC ID: 9032576566 Enrollment ID: I20230526002622 |
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