MEDICARE: MENAGER FAMILY CLINIC LLC

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	261QP2300X	Primary Care Clinic/Center	AP114056	TX

General Provider Information

NPI Number	:	1265889703
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MENAGER FAMILY CLINIC LLC

Provider Business Mailing Address
First Line	:	404 E JONES ST
Second Line	:
City	:	BEEVILLE
State	:	TX
Zip	:	78102-3532
Country	:	US
Telephone Number	:	361-542-1426
Fax Number	:

Provider Business Practice Location Address
First Line	:	1406 E HOUSTON ST
Second Line	:	SUITE B
City	:	BEEVILLE
State	:	TX
Zip	:	78102-5346
Country	:	US
Telephone Number	:	361-542-1426
Fax Number	:	361-881-4291

Authorized Official
Title or Position	:	SOLE MBR
Name	:	KATHERINE FAYE MENAGER
Credential	:	APRN
Telephone Number	:	361-542-1426

Provider Enumeration Date	:	05/14/2016
Last Update Date	:	09/02/2016

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