| Smsc | |
|
150 River North Blvd Stephenville TX 76401-1803 | |
| (254) 968-6051 | |
| (254) 968-4950 |
| Full Name | Smsc |
|---|---|
| Speciality | Family Medicine |
| Location | 150 River North Blvd, Stephenville, Texas |
| Authorized Official Name and Position | Janie Mcmillion (PHYSICIAN CLINIC ADMINISTRATOR) |
| Authorized Official Contact | 2549686051 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Smsc 150 River North Blvd Stephenville TX 76401-1803 Ph: (254) 968-6051 | Smsc 150 River North Blvd Stephenville TX 76401-1803 Ph: (254) 968-6051 |
| NPI Number | 1912902826 |
|---|---|
| Provider Enumeration Date | 06/16/2005 |
| Last Update Date | 11/03/2014 |
| Medicare PECOS PAC ID | 3779578612 |
|---|---|
| Medicare Enrollment ID | O20040419001313 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1912902826 | NPI | - | NPPES |
| 112052901 | Medicaid | TX | |
| 112052902 | Medicaid | TX | |
| 00E762 | Other | TX | GROUP BCBS PROVIDER NUMBE |
| 0411240001 | Other | TX | DME CIGNA GOVERNMENT SERV |
| CA8089 | Other | TX | GROUP RAILROAD MEDICARE # |
| Provider Name | Charles S Erck |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1811992407 PECOS PAC ID: 3274528161 Enrollment ID: I20040701000572 |
| Provider Name | David C Boucher |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1639174675 PECOS PAC ID: 3870588759 Enrollment ID: I20070417000412 |
| Provider Name | Delbert C Rudy |
|---|---|
| Provider Type | Practitioner - Urology |
| Provider Identifiers | NPI Number: 1386630481 PECOS PAC ID: 9931247723 Enrollment ID: I20091116000561 |
| Provider Name | Frank V Terrell |
|---|---|
| Provider Type | Practitioner - Ophthalmology |
| Provider Identifiers | NPI Number: 1750375200 PECOS PAC ID: 7719972603 Enrollment ID: I20091207000605 |
| Provider Name | Jeffrey D Moore |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1023014008 PECOS PAC ID: 9931194826 Enrollment ID: I20091215000237 |
| Provider Name | Lester C Ong |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1255337119 PECOS PAC ID: 1951396837 Enrollment ID: I20091221000244 |
| Provider Name | James W Smith |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1053316745 PECOS PAC ID: 7416942388 Enrollment ID: I20091223000203 |
| Provider Name | Helen C Ong |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1467458448 PECOS PAC ID: 2860487733 Enrollment ID: I20100708000951 |
| Provider Name | Rhonda J Burd |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1588669675 PECOS PAC ID: 2567594468 Enrollment ID: I20100712000684 |
| Provider Name | Kam W Ip |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1174529523 PECOS PAC ID: 3870588767 Enrollment ID: I20100826000810 |
| Provider Name | Samantha N Pehl |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1629210901 PECOS PAC ID: 5799961405 Enrollment ID: I20110513000541 |
| Provider Name | Miranda A Nash |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1235398140 PECOS PAC ID: 2769650308 Enrollment ID: I20110726000263 |
| Provider Name | Nadine T Rose |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1538365655 PECOS PAC ID: 3375676695 Enrollment ID: I20111019000128 |
| Provider Name | Kevin A Kerr |
|---|---|
| Provider Type | Practitioner - Ophthalmology |
| Provider Identifiers | NPI Number: 1407052780 PECOS PAC ID: 0547438095 Enrollment ID: I20111019000141 |
| Provider Name | Trevor J Kerr |
|---|---|
| Provider Type | Practitioner - Ophthalmology |
| Provider Identifiers | NPI Number: 1396919361 PECOS PAC ID: 3375709686 Enrollment ID: I20120731000461 |
| Provider Name | Benjamin A Marcum |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1588892004 PECOS PAC ID: 1557517547 Enrollment ID: I20120807000478 |
| Provider Name | Robert Byron Mitchell |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1346684313 PECOS PAC ID: 5799903886 Enrollment ID: I20160603000873 |
| Provider Name | Cortney Fanning |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1265917918 PECOS PAC ID: 0244583573 Enrollment ID: I20181102000339 |
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