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600 Memory Lane Somerville TX 77879-0995 | |
(979) 776-2426 | |
(979) 776-5948 |
Full Name | |
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Speciality | Clinic/center - Rural Health |
Location | 600 Memory Lane, Somerville, Texas |
Authorized Official Name and Position | Rena White (PATIENT FINANCIAL SERVICES MANAGER) |
Authorized Official Contact | 9797762426 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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Po Box 202536 Dallas TX 75320-2536 Ph: (979) 776-2426 | 600 Memory Lane Somerville TX 77879-0995 Ph: (979) 776-2426 |
NPI Number | 1467510271 |
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Provider Enumeration Date | 12/05/2006 |
Last Update Date | 02/02/2009 |
Identifier | Type | State | Issuer |
---|---|---|---|
1467510271 | NPI | - | NPPES |
063335601 | Medicaid | TX | |
192459901 | Medicaid | TX | |
018213101 | Other | TX | EPSDT |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QR1300X | Clinic/center - Rural Health | 000679 (Texas) | Primary |