MEDICARE: KEVIN UPTERGROVE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QR1300X	Rural Health Clinic/Center

General Provider Information

NPI Number	:	1568655892
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KEVIN UPTERGROVE

Provider Business Mailing Address
First Line	:	PO BOX 509
Second Line	:
City	:	SABINAL
State	:	TX
Zip	:	78881-0509
Country	:	US
Telephone Number	:	830-988-2985
Fax Number	:	830-988-2140

Provider Business Practice Location Address
First Line	:	517 N. CENTER
Second Line	:
City	:	SABINAL
State	:	TX
Zip	:	78881-0509
Country	:	US
Telephone Number	:	830-988-2985
Fax Number	:	830-988-2140

Authorized Official
Title or Position	:	OWNER
Name	:	MR. KEVIN UPTERGROVE
Credential	:	MD
Telephone Number	:	830-988-2985

Provider Enumeration Date	:	08/21/2007
Last Update Date	:	08/21/2007

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Directions to “KEVIN UPTERGROVE ” Practice Location

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