MEDICARE: PACKARD MEDICAL GROUP, P.A.

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	261Q00000X	Clinic/Center

General Provider Information

NPI Number	:	1811196629
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PACKARD MEDICAL GROUP, P.A.

Provider Business Mailing Address
First Line	:	PO BOX 1948
Second Line	:
City	:	HEMPHILL
State	:	TX
Zip	:	75948-1948
Country	:	US
Telephone Number	:	409-584-2411
Fax Number	:	409-584-3884

Provider Business Practice Location Address
First Line	:	105 TIMBERLAND HWY
Second Line	:
City	:	PINELAND
State	:	TX
Zip	:	75968
Country	:	US
Telephone Number	:	409-584-2411
Fax Number	:	409-584-3884

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	JOY PACKARD
Credential	:
Telephone Number	:	409-787-3520

Provider Enumeration Date	:	07/12/2007
Last Update Date	:	11/09/2007

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Directions to “PACKARD MEDICAL GROUP, P.A. ” Practice Location

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