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813 E 4th St Monahans TX 79756-4015 | |
(432) 943-2068 | |
(432) 943-3114 |
Full Name | |
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Speciality | Clinic/Center |
Location | 813 E 4th St, Monahans, Texas |
Authorized Official Name and Position | Leticia Rodriguez (CEO) |
Authorized Official Contact | 4329432511 |
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 40 Monahans TX 79756-0040 Ph: (432) 943-2068 | 813 E 4th St Monahans TX 79756-4015 Ph: (432) 943-2068 |
NPI Number | 1588672448 |
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Provider Enumeration Date | 08/04/2006 |
Last Update Date | 01/28/2014 |
Medicare PECOS PAC ID | 1456261494 |
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Medicare Enrollment ID | O20030624000022 |
Identifier | Type | State | Issuer |
---|---|---|---|
1588672448 | NPI | - | NPPES |
0064HD | Other | TX | BLUE CROSS BLUE SHIELD TX |
105864100 | Other | TX | FIRSTCARE SW HEALTH |
092075302 | Other | TX | CHIPS |
092075302 | Medicaid | TX |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QR1300X | Clinic/center - Rural Health | 000468 (Texas) | Primary |