| Sparks Clinic Pa | |
|
103 N 1st Street Rockwall TX 75087-3033 | |
| (972) 771-5366 | |
| (972) 771-0424 |
| Full Name | Sparks Clinic Pa |
|---|---|
| Speciality | Family Medicine |
| Location | 103 N 1st Street, Rockwall, Texas |
| Authorized Official Name and Position | Robert Dale Sparks (OWNER) |
| Authorized Official Contact | 9727715366 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Sparks Clinic Pa 103 N 1st St Rockwall TX 75087-3033 Ph: (972) 771-5366 | Sparks Clinic Pa 103 N 1st Street Rockwall TX 75087-3033 Ph: (972) 771-5366 |
| NPI Number | 1841214467 |
|---|---|
| Provider Enumeration Date | 07/27/2006 |
| Last Update Date | 07/28/2008 |
| Medicare PECOS PAC ID | 9133292048 |
|---|---|
| Medicare Enrollment ID | O20080724000561 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1841214467 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | F0682 (Texas) | Primary |
| Provider Name | Robert D Sparks |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1215985312 PECOS PAC ID: 0446354286 Enrollment ID: I20070403000539 |
| Provider Name | Michael R Jackson |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1053467902 PECOS PAC ID: 8224195714 Enrollment ID: I20090327000351 |
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