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1912902826

NPI Code Detail

MEDICARE: STEPHENVILLE MEDICAL AND SURGICAL CLINIC PA

MEDICARE: STEPHENVILLE MEDICAL AND SURGICAL CLINIC PA

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
2	207RC0000X	Cardiovascular Disease Physician	NA	TX
3	207RC0000X	Cardiovascular Disease Physician
4	207U00000X	Nuclear Medicine Physician
5	207V00000X	Obstetrics & Gynecology Physician
6	207X00000X	Orthopaedic Surgery Physician
7	207Y00000X	Otolaryngology Physician
8	207Q00000X	Family Medicine Physician	NA	TX

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
5	CA8089	OTHER	TX	GROUP RAILROAD MEDICARE #

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	00E762	OTHER	TX	GROUP BCBS PROVIDER NUMBE
4	0411240001	OTHER	TX	DME CIGNA GOVERNMENT SERV

General Provider Information

NPI Number	:	1912902826
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	STEPHENVILLE MEDICAL AND SURGICAL CLINIC PA

Provider Business Mailing Address
First Line	:	150 RIVER NORTH BLVD
Second Line	:
City	:	STEPHENVILLE
State	:	TX
Zip	:	76401-1803
Country	:	US
Telephone Number	:	254-968-6051
Fax Number	:	254-968-4950

Provider Business Practice Location Address
First Line	:	150 RIVER NORTH BLVD
Second Line	:
City	:	STEPHENVILLE
State	:	TX
Zip	:	76401-1803
Country	:	US
Telephone Number	:	254-968-6051
Fax Number	:	254-968-4950

Authorized Official
Title or Position	:	PHYSICIAN CLINIC ADMINISTRATOR
Name	:	DR. JANIE MCMILLION
Credential	:	M.D.
Telephone Number	:	254-968-6051

Provider Enumeration Date	:	06/16/2005
Last Update Date	:	11/03/2014

Similar Medicare Providers

1588669675 — MS. RHONDA BURD RN, ANP
Practice Location Address:

150 RIVER NORTH BLVD
STEPHENVILLE, TX
76401-1803

Practice Phone: 254-968-6051
Practice Fax: 254-968-4950

1063417038 — MS. ANITA BUTLER RD, LD
Practice Location Address:

150 RIVER NORTH BLVD
STEPHENVILLE, TX
76401-1803

Practice Phone: 254-968-6051
Practice Fax: 254-968-4950

1639174675 — DAVID BOUCHER MD
Practice Location Address:

150 RIVER NORTH BLVD
STEPHENVILLE, TX
76401-1803

Practice Phone: 254-968-6051
Practice Fax: 254-968-4204

1407851009 — DR. C RICHARD FRAZIER M.D.
Practice Location Address:

150 RIVER NORTH BLVD
STEPHENVILLE, TX
76401-1803

Practice Phone: 254-968-6051
Practice Fax: 254-968-4204

1811992407 — DR. CHARLES S ERCK M.D.
Practice Location Address:

150 RIVER NORTH BLVD
STEPHENVILLE, TX
76401-1803

Practice Phone: 254-968-6051
Practice Fax: 254-968-4204

1619972221 — DR. DENNIS GRAHAM D.O.
Practice Location Address:

150 RIVER NORTH BLVD
STEPHENVILLE, TX
76401-1803

Practice Phone: 254-968-6051
Practice Fax: 254-968-4204

Directions to “STEPHENVILLE MEDICAL AND SURGICAL CLINIC PA ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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