| Temple Memorial Pediatric Center Inc. | |
|
1710 Moores Ln Texarkana TX 75503-1858 | |
| (903) 794-2705 | |
| (903) 793-1203 |
| Full Name | Temple Memorial Pediatric Center Inc. |
|---|---|
| Speciality | Clinic/Center |
| Location | 1710 Moores Ln, Texarkana, Texas |
| Authorized Official Name and Position | Sandra K Varner (CEO) |
| Authorized Official Contact | 9037942705 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Temple Memorial Pediatric Center Inc. 1710 Moores Ln Texarkana TX 75503-1858 Ph: (903) 794-2705 | Temple Memorial Pediatric Center Inc. 1710 Moores Ln Texarkana TX 75503-1858 Ph: (903) 794-2705 |
| NPI Number | 1972654663 |
|---|---|
| Provider Enumeration Date | 01/16/2007 |
| Last Update Date | 04/10/2024 |
| Certification Date | 04/10/2024 |
| Medicare PECOS PAC ID | 8224949870 |
|---|---|
| Medicare Enrollment ID | O20100416000600 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1972654663 | NPI | - | NPPES |
| 8P097 | Other | TX | ARKANSAS BCBS |
| 116506742 | Medicaid | AR | |
| 00T7468 | Other | TX | BCBS OF TEXAS |
| 021289601 | Medicaid | TX |
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