MEDICARE: NEXTCARE PRIMARY CARE SOUTH TEXAS PLLC

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	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1578921524
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEXTCARE PRIMARY CARE SOUTH TEXAS PLLC

Provider Business Mailing Address
First Line	:	1602 E HOUSTON ST
Second Line	:
City	:	BEEVILLE
State	:	TX
Zip	:	78102-5326
Country	:	US
Telephone Number	:	480-776-1600
Fax Number	:	480-776-1605

Provider Business Practice Location Address
First Line	:	2550 N THUNDERBIRD CIR
Second Line	:
City	:	MESA
State	:	AZ
Zip	:	85215-1219
Country	:	US
Telephone Number	:	480-776-1600
Fax Number	:	480-776-1605

Authorized Official
Title or Position	:	VP OF REIMBURSEMENT SERVICIES
Name	:	KEITH MARPLE
Credential	:
Telephone Number	:	480-776-1600

Provider Enumeration Date	:	02/05/2016
Last Update Date	:	05/01/2016

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