| Full Name | |
|---|---|
| Speciality | Clinic/center - Rural Health |
| Location | 307 Woodlawn, Kilgore, Texas |
| Authorized Official Name and Position | Mary Ann Harrison (PROVIDER ENROLLMENT COORDINATOR) |
| Authorized Official Contact | 9035101113 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
Po Box 846098 Dallas TX 75284-6098 Ph: (903) 324-6400 | 307 Woodlawn Kilgore TX 75662-3624 Ph: (903) 983-2110 |
| NPI Number | 1861618779 |
|---|---|
| Provider Enumeration Date | 04/18/2007 |
| Last Update Date | 09/25/2012 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1861618779 | NPI | - | NPPES |
| 201442502 | Medicaid | TX | |
| 201442501 | Medicaid | TX |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QR1300X | Clinic/center - Rural Health | (* (Not Available)) | Primary |
Carebridge Medteam, Llc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 1600 S Henderson Blvd, Kilgore, TX 75662 Phone: 903-475-3474 | |
Michael W. Mcshan, M.d., P.a. Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 1711 S Henderson Blvd, Suite 300, Kilgore, TX 75662 Phone: 903-983-1578 | |
Qv Urgent Care Tx Pllc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 1016 N Kilgore St, Kilgore, TX 75662 Phone: 903-522-4199 | |
Community Wound Resource, Llc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 1600 S Henderson Blvd, Kilgore, TX 75662 Phone: 903-475-2713 Fax: 903-942-2930 | |