MEDICARE: CLINICAL PARTNERS PA - KINGSVILLE

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	207L00000X	Anesthesiology Physician

General Provider Information

NPI Number	:	1174552871
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CLINICAL PARTNERS PA - KINGSVILLE

Provider Business Mailing Address
First Line	:	PO BOX 5188
Second Line	:
City	:	LONGVIEW
State	:	TX
Zip	:	75608-5188
Country	:	US
Telephone Number	:	903-663-3600
Fax Number	:	866-777-9502

Provider Business Practice Location Address
First Line	:	1311 GENERAL CAVAZOS BLVD
Second Line	:
City	:	KINGSVILLE
State	:	TX
Zip	:	78363-7129
Country	:	US
Telephone Number	:	903-663-3600
Fax Number	:	866-777-9502

Authorized Official
Title or Position	:	OWNER
Name	:	HAROLD LEE BOLNICK
Credential	:	M.D.
Telephone Number	:	903-261-7297

Provider Enumeration Date	:	07/03/2006
Last Update Date	:	08/22/2020

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