| Dekalb Physicians Clinic Llc | |
|
1250 S Runnels St De Kalb TX 75559-2317 | |
| (903) 667-2273 | |
| (903) 667-7597 |
| Full Name | Dekalb Physicians Clinic Llc |
|---|---|
| Speciality | Family Medicine |
| Location | 1250 S Runnels St, De Kalb, Texas |
| Authorized Official Name and Position | Kyle Wayne Groom (OWNER - PHYSICIAN) |
| Authorized Official Contact | 9036672273 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Dekalb Physicians Clinic Llc 216 N Centre St De Kalb TX 75559-1406 Ph: (903) 667-2273 | Dekalb Physicians Clinic Llc 1250 S Runnels St De Kalb TX 75559-2317 Ph: (903) 667-2273 |
| NPI Number | 1265565691 |
|---|---|
| Provider Enumeration Date | 03/14/2007 |
| Last Update Date | 01/30/2023 |
| Medicare PECOS PAC ID | 0244264216 |
|---|---|
| Medicare Enrollment ID | O20050920000946 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1265565691 | NPI | - | NPPES |
| 8S7090 | Other | TX | BLUE CROSS BLUE SHIELD |
| 177214701 | Medicaid | TX | |
| 8P152 | Other | AR | ARK BLUE CROSS BLUE SHIEL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | L5749 (Texas) | Primary |
| Provider Name | Kyle W Groom |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1063413656 PECOS PAC ID: 2264424456 Enrollment ID: I20040330001205 |
| Provider Name | Almer Hadaway |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1720416308 PECOS PAC ID: 5890912109 Enrollment ID: I20160827000137 |
| Provider Name | Lee A Mccrary |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1427411032 PECOS PAC ID: 6709155427 Enrollment ID: I20170711003072 |
| Provider Name | Cody Jo Sanford |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1740886704 PECOS PAC ID: 6002261054 Enrollment ID: I20231011000354 |
Beacon Integrated Healthcare Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 118 Wood St Ofc 1, De Kalb, TX 75559 Phone: 903-417-5377 |