| St. Alyssa Medical Center | |
|
2805 North St Ste E Nacogdoches TX 75965-2800 | |
| (936) 205-3171 | |
| (936) 205-3174 |
| Full Name | St. Alyssa Medical Center |
|---|---|
| Speciality | Family Medicine |
| Location | 2805 North St Ste E, Nacogdoches, Texas |
| Authorized Official Name and Position | Michael L. Bishop (CLINIC DIRECTOR) |
| Authorized Official Contact | 9366451586 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| St. Alyssa Medical Center Po Box 635312 Nacogdoches TX 75963 Ph: (936) 645-1586 | St. Alyssa Medical Center 2805 North St Ste E Nacogdoches TX 75965-2800 Ph: (936) 205-3171 |
| NPI Number | 1710425541 |
|---|---|
| Provider Enumeration Date | 01/31/2017 |
| Last Update Date | 11/28/2022 |
| Medicare PECOS PAC ID | 0547695082 |
|---|---|
| Medicare Enrollment ID | O20200110001662 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1710425541 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| 261QR1300X | Clinic/center - Rural Health | (* (Not Available)) | Secondary |
| Provider Name | Gunda Kirk |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1831212844 PECOS PAC ID: 0840565123 Enrollment ID: I20171012002111 |
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