MEDICARE: GEORGE RURAL HEALTH CENTER 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	261QR1300X	Rural Health Clinic/Center

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	080106971	OTHER		RR MEDICARE
2	00258V	OTHER	TX	MEDICARE PART B PIN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	0042GW	OTHER	TX	BCBS
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1942369178
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GEORGE RURAL HEALTH CENTER PA

Provider Business Mailing Address
First Line	:	511 NORTH MAIN
Second Line	:
City	:	FORT STOCKTON
State	:	TX
Zip	:	79735-5623
Country	:	US
Telephone Number	:	432-336-2291
Fax Number	:	432-336-3557

Provider Business Practice Location Address
First Line	:	511 NORTH MAIN
Second Line	:
City	:	FORT STOCKTON
State	:	TX
Zip	:	79735-5623
Country	:	US
Telephone Number	:	432-336-2291
Fax Number	:	432-336-3557

Authorized Official
Title or Position	:	OWNER
Name	:	CECIL R GEORGE
Credential	:	MD
Telephone Number	:	432-336-2291

Provider Enumeration Date	:	12/06/2006
Last Update Date	:	12/17/2009

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Directions to “GEORGE RURAL HEALTH CENTER PA ” Practice Location

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