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General NPI Number Information
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NPI Number | 1497123772
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Entity Type | Organization
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Legal Business Name | TEXOMA PRIMARY CARE CLINIC
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Dates
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Enumeration Date | 09/03/2015
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Last Update Date | 09/03/2015
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Provider Practice Location Address
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Address Line | 5500 KELL BLVD SUITE 500
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City | WICHITA FALLS
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State | TX
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Zip | 76310-1612
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Country | US
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Telephone | 940-264-2273
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Fax |
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Provider Business Mailing Address
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Address Line | 5500 KELL BLVD SUITE 500
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City | WICHITA FALLS
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State | TX
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Zip | 76310-1612
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Country | US
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Telephone | 940-264-2273
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | JERRY K MYERS
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Credential | M.D.
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Telephone | 940-696-7518
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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