| Stone Creek Family Medicine | |
|
19782 Highway 105 W Suite 111 Montgomery TX 77356-3103 | |
| (936) 582-0220 | |
| Not Available |
| Full Name | Stone Creek Family Medicine |
|---|---|
| Speciality | Family Medicine |
| Location | 19782 Highway 105 W, Montgomery, Texas |
| Authorized Official Name and Position | Jeremy K Mcwilliams (OWNER/PROVIDER) |
| Authorized Official Contact | 9365820220 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Stone Creek Family Medicine 19782 Highway 105 W Suite 111 Montgomery TX 77356-3103 Ph: (936) 582-0220 | Stone Creek Family Medicine 19782 Highway 105 W Suite 111 Montgomery TX 77356-3103 Ph: (936) 582-0220 |
| NPI Number | 1962955864 |
|---|---|
| Provider Enumeration Date | 07/27/2016 |
| Last Update Date | 09/05/2019 |
| Medicare PECOS PAC ID | 5294066213 |
|---|---|
| Medicare Enrollment ID | O20191004003081 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1962955864 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| 363LF0000X | Nurse Practitioner - Family | (* (Not Available)) | Secondary |
| Provider Name | Jeremy K Mcwilliams |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1851325823 PECOS PAC ID: 4880625292 Enrollment ID: I20050825000653 |
| Provider Name | Jennifer L Ligon-gaston |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1780037861 PECOS PAC ID: 1052687548 Enrollment ID: I20171027002498 |
| Provider Name | Ginger L Mcmillian |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1306237664 PECOS PAC ID: 7517233828 Enrollment ID: I20171031002236 |
| Provider Name | Courtney Groves |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1952994386 PECOS PAC ID: 4587066402 Enrollment ID: I20210714001402 |
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