MEDICARE: BOYD MEDICAL CLINIC

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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1992720536
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BOYD MEDICAL CLINIC

Provider Business Mailing Address
First Line	:	PO BOX 935
Second Line	:
City	:	BOYD
State	:	TX
Zip	:	76023-0935
Country	:	US
Telephone Number	:	940-433-5122
Fax Number	:	940-433-8309

Provider Business Practice Location Address
First Line	:	308 W ROCK ISLAND AVE
Second Line	:
City	:	BOYD
State	:	TX
Zip	:	76023-0308
Country	:	US
Telephone Number	:	940-433-5122
Fax Number	:	940-433-8309

Authorized Official
Title or Position	:	MD
Name	:	TIMOTHY W. MCINTYRE
Credential	:	MD
Telephone Number	:	940-433-5122

Provider Enumeration Date	:	07/13/2006
Last Update Date	:	12/07/2010

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1417107905 — JAMES DILLON MOORE FNP
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Directions to “BOYD MEDICAL CLINIC ” Practice Location

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