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1901 Mulberry Ave Ste A Mount Pleasant TX 75455-2369 | |
(903) 758-2610 | |
(903) 758-7081 |
Full Name | |
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Speciality | Clinic/Center |
Location | 1901 Mulberry Ave Ste A, Mount Pleasant, Texas |
Authorized Official Name and Position | Timothy Chad Jones (CEO) |
Authorized Official Contact | 9037582610 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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1107 E Marshall Ave Longview TX 75601-5602 Ph: (903) 758-2610 | 1901 Mulberry Ave Ste A Mount Pleasant TX 75455-2369 Ph: (903) 758-2610 |
NPI Number | 1710515630 |
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Provider Enumeration Date | 03/27/2020 |
Last Update Date | 01/15/2025 |
Medicare PECOS PAC ID | 1254367766 |
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Medicare Enrollment ID | O20200415000420 |
Identifier | Type | State | Issuer |
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1710515630 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |