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105 Hospital Ave Tulia TX 79088-2433 | |
(806) 995-4122 | |
(806) 995-4663 |
Full Name | |
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Speciality | Clinic/Center |
Location | 105 Hospital Ave, Tulia, Texas |
Authorized Official Name and Position | Luke Brewer (CEO) |
Authorized Official Contact | 8069953581 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Po Box 846 Tulia TX 79088-0846 Ph: (806) 995-3581 | 105 Hospital Ave Tulia TX 79088-2433 Ph: (806) 995-4122 |
NPI Number | 1245526961 |
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Provider Enumeration Date | 06/21/2011 |
Last Update Date | 03/07/2022 |
Medicare PECOS PAC ID | 2365610490 |
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Medicare Enrollment ID | O20110715000653 |
Identifier | Type | State | Issuer |
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1245526961 | NPI | - | NPPES |
312084201 | Medicaid | TX |
Taxonomy | Type | License (State) | Status |
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261QR1300X | Clinic/center - Rural Health | 000273 (Texas) | Primary |