| Sycamore Family Medicine | |
|
1502 12th St Ste A Shallowater TX 79363-5651 | |
| (806) 832-4566 | |
| Not Available |
| Full Name | Sycamore Family Medicine |
|---|---|
| Speciality | Family Medicine |
| Location | 1502 12th St Ste A, Shallowater, Texas |
| Authorized Official Name and Position | Brian Carreon (OWNER/PROVIDER) |
| Authorized Official Contact | 8063925935 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Sycamore Family Medicine Po Box 2088 Shallowater TX 79363-2088 Ph: (806) 832-4566 | Sycamore Family Medicine 1502 12th St Ste A Shallowater TX 79363-5651 Ph: (806) 832-4566 |
| NPI Number | 1245843051 |
|---|---|
| Provider Enumeration Date | 08/31/2020 |
| Last Update Date | 01/05/2021 |
| Certification Date | 01/05/2021 |
| Medicare PECOS PAC ID | 8628496460 |
|---|---|
| Medicare Enrollment ID | O20200910003529 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1245843051 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | () | Primary |
| Provider Name | Brian K Carreon |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1831162221 PECOS PAC ID: 1658332234 Enrollment ID: I20041026001127 |
| Provider Name | Cara Baker |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1649643636 PECOS PAC ID: 7517267024 Enrollment ID: I20151204000576 |
| Provider Name | Brittney Bailey |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1578013314 PECOS PAC ID: 6507144201 Enrollment ID: I20161101000808 |
| Provider Name | Mackenzi Brooke Eberly |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1598146433 PECOS PAC ID: 9032486634 Enrollment ID: I20170602001183 |