| |
153 Barge Rd Zavalla TX 75980-3003 | |
(936) 897-1002 | |
(936) 647-1041 |
Full Name | |
---|---|
Speciality | Clinic/Center |
Location | 153 Barge Rd, Zavalla, Texas |
Authorized Official Name and Position | Robert Young (PHYSICIAN) |
Authorized Official Contact | 9368971002 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
---|---|
Po Box 594 Zavalla TX 75980 Ph: (936) 897-1002 | 153 Barge Rd Zavalla TX 75980-3003 Ph: (936) 897-1002 |
NPI Number | 1114455375 |
---|---|
Provider Enumeration Date | 05/31/2017 |
Last Update Date | 10/17/2024 |
Medicare PECOS PAC ID | 5698021657 |
---|---|
Medicare Enrollment ID | O20190111001625 |
Identifier | Type | State | Issuer |
---|---|---|---|
1114455375 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QR1300X | Clinic/center - Rural Health | (* (Not Available)) | Primary |
363A00000X | Physician Assistant | PA03871 (Texas) | Secondary |