| |
525 Ranch Road 2900 Kingsland TX 78639-6000 | |
(512) 715-3106 | |
(325) 388-6935 |
Full Name | |
---|---|
Speciality | Clinic/Center |
Location | 525 Ranch Road 2900, Kingsland, Texas |
Authorized Official Name and Position | William Davis (PRESIDENT CEO) |
Authorized Official Contact | 5123241867 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
---|---|
Po Box 204229 Dallas TX 75320-4229 Ph: (325) 388-6912 | 525 Ranch Road 2900 Kingsland TX 78639-6000 Ph: (512) 715-3106 |
NPI Number | 1205263134 |
---|---|
Provider Enumeration Date | 10/10/2013 |
Last Update Date | 09/11/2023 |
Medicare PECOS PAC ID | 5193634293 |
---|---|
Medicare Enrollment ID | O20140228001646 |
Identifier | Type | State | Issuer |
---|---|---|---|
1205263134 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207Q00000X | Family Medicine | (* (Not Available)) | Secondary |
261QR1300X | Clinic/center - Rural Health | 00559 (Texas) | Primary |