| Primary Doc | |
|
2132 South 1st Street Lufkin TX 75901-7124 | |
| (936) 634-3627 | |
| Not Available |
| Full Name | Primary Doc |
|---|---|
| Speciality | Family Medicine |
| Location | 2132 South 1st Street, Lufkin, Texas |
| Authorized Official Name and Position | Michael Iversen (CEO) |
| Authorized Official Contact | 9364658860 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Primary Doc Po Box 153120 Lufkin TX 75915-3120 Ph: (936) 633-2396 | Primary Doc 2132 South 1st Street Lufkin TX 75901-7124 Ph: (936) 634-3627 |
| NPI Number | 1518589167 |
|---|---|
| Provider Enumeration Date | 05/16/2020 |
| Last Update Date | 02/17/2023 |
| Medicare PECOS PAC ID | 0446615025 |
|---|---|
| Medicare Enrollment ID | O20230504000421 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1518589167 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Michael G Iversen |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1760494074 PECOS PAC ID: 2062594575 Enrollment ID: I20080303000336 |
| Provider Name | Krista L Tabler Gresham |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1700243730 PECOS PAC ID: 7618248360 Enrollment ID: I20170731000709 |
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