| Sealy Family Practice Clinic | |
|
826 S Meyer St Sealy TX 77474-3433 | |
| (979) 627-0795 | |
| (979) 627-0799 |
| Full Name | Sealy Family Practice Clinic |
|---|---|
| Speciality | Family Medicine |
| Location | 826 S Meyer St, Sealy, Texas |
| Authorized Official Name and Position | Isidro G De Leon (PRESIDENT/CEO) |
| Authorized Official Contact | 9796270795 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Sealy Family Practice Clinic 826 S Meyer St Sealy TX 77474-3433 Ph: (979) 627-0795 | Sealy Family Practice Clinic 826 S Meyer St Sealy TX 77474-3433 Ph: (979) 627-0795 |
| NPI Number | 1528001526 |
|---|---|
| Provider Enumeration Date | 06/14/2006 |
| Last Update Date | 08/31/2010 |
| Medicare PECOS PAC ID | 9638140726 |
|---|---|
| Medicare Enrollment ID | O20040803000663 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1528001526 | NPI | - | NPPES |
| 144735101 | Medicaid | TX | |
| 00515R | Other | TX | BCBS |
| 5658340001 | Other | TX | MEDICARE NSC |
| 00515R | Other | TX | MEDICARE |
| CH7975 | Other | TX | RAILROAD MEDICARE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | K7714 (Texas) | Primary |
| Provider Name | Isidro Guadalupe De Leon |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1942236856 PECOS PAC ID: 6709857899 Enrollment ID: I20100826000434 |
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