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125 W Park Ave Hereford TX 79045-4201 | |
| (806) 364-7688 | |
| (806) 364-7694 |
| Full Name | |
|---|---|
| Speciality | Clinic/Center |
| Location | 125 W Park Ave, Hereford, Texas |
| Authorized Official Name and Position | Rick C Love (CEO) |
| Authorized Official Contact | 8062938561 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
2801 W 8th St Plainview TX 79072-6737 Ph: (806) 293-8561 | 125 W Park Ave Hereford TX 79045-4201 Ph: (806) 364-7688 |
| NPI Number | 1588662027 |
|---|---|
| Provider Enumeration Date | 07/08/2005 |
| Last Update Date | 05/09/2024 |
| Medicare PECOS PAC ID | 5698682557 |
|---|---|
| Medicare Enrollment ID | O20060926000596 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1588662027 | NPI | - | NPPES |
| 019041501 | Medicaid | TX |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | F1756 (Texas) | Primary |
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