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1208 W Henderson St Ste A Cleburne TX 76033-8773 | |
| (682) 317-1500 | |
| (682) 317-1553 |
| Full Name | |
|---|---|
| Speciality | Clinic/Center |
| Location | 1208 W Henderson St Ste A, Cleburne, Texas |
| Authorized Official Name and Position | Jason Nicholas (VP OF OPERATIONS) |
| Authorized Official Contact | 3256420073 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
1208 W Henderson St Cleburne TX 76033-8731 Ph: (325) 603-3900 | 1208 W Henderson St Ste A Cleburne TX 76033-8773 Ph: (682) 317-1500 |
| NPI Number | 1558811083 |
|---|---|
| Provider Enumeration Date | 10/07/2016 |
| Last Update Date | 11/13/2024 |
| Medicare PECOS PAC ID | 4082997861 |
|---|---|
| Medicare Enrollment ID | O20170202001375 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1558811083 | NPI | - | NPPES |
| N4614 | Other | TX | STATE LICENSE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (* (Not Available)) | Secondary |
| 261QU0200X | Clinic/center - Urgent Care | (* (Not Available)) | Primary |
| Provider Name | Brian S Nelson |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1255499943 PECOS PAC ID: 4284778127 Enrollment ID: I20100216000781 |
| Provider Name | Foad A Farahmand |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1972823169 PECOS PAC ID: 0042469447 Enrollment ID: I20140522001715 |
| Provider Name | Mary Catherine Moody |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1891193744 PECOS PAC ID: 7719285428 Enrollment ID: I20160413001925 |
| Provider Name | Shelly R Smith |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1730263500 PECOS PAC ID: 0840553046 Enrollment ID: I20180423001968 |
| Provider Name | Elizabeth Mora |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1326429226 PECOS PAC ID: 5395094478 Enrollment ID: I20180822003120 |
| Provider Name | Kilea Lanay Johnson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1013447101 PECOS PAC ID: 5799038774 Enrollment ID: I20181020000059 |
| Provider Name | Sweta Kishor Manek |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1487125191 PECOS PAC ID: 3779824081 Enrollment ID: I20190416000114 |
| Provider Name | Michelle Oyenekan |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1073126595 PECOS PAC ID: 6002236007 Enrollment ID: I20201013001558 |
| Provider Name | Lucas L Lopez |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1912503160 PECOS PAC ID: 4789082603 Enrollment ID: I20211007001300 |
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