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301 S Main St Cross Plains TX 76443-2581 | |
(254) 725-4311 | |
(254) 725-4313 |
Full Name | |
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Speciality | Clinic/Center |
Location | 301 S Main St, Cross Plains, Texas |
Authorized Official Name and Position | Tina Louise Betcher (BILLING MANAGER/CREDENTIALER) |
Authorized Official Contact | 3258934010 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Po Box 2435 Albany TX 76430-8020 Ph: (325) 762-2447 | 301 S Main St Cross Plains TX 76443-2581 Ph: (254) 725-4311 |
NPI Number | 1881985299 |
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Provider Enumeration Date | 04/20/2011 |
Last Update Date | 09/17/2014 |
Medicare PECOS PAC ID | 8628027174 |
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Medicare Enrollment ID | O20080609000104 |
Identifier | Type | State | Issuer |
---|---|---|---|
1881985299 | NPI | - | NPPES |
214962701 | Medicaid | TX |
Taxonomy | Type | License (State) | Status |
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261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | 30117281979 (Texas) | Primary |