| Dr. Fredric Puckett, PLLC | |
|
2203 W Lampasas St Ste 111 Ennis TX 75119-5667 | |
| (972) 875-6200 | |
| (972) 875-6414 |
| Full Name | Dr. Fredric Puckett, PLLC |
|---|---|
| Speciality | Family Medicine |
| Location | 2203 W Lampasas St Ste 111, Ennis, Texas |
| Authorized Official Name and Position | Fredric Clark Puckett (PHYSICIAN/OWNER) |
| Authorized Official Contact | 9728756200 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Dr. Fredric Puckett, PLLC 2203 W Lampasas St Ste 111 Ennis TX 75119-5667 Ph: (972) 875-6200 | Dr. Fredric Puckett, PLLC 2203 W Lampasas St Ste 111 Ennis TX 75119-5667 Ph: (972) 875-6200 |
| NPI Number | 1073748562 |
|---|---|
| Provider Enumeration Date | 05/27/2009 |
| Last Update Date | 06/13/2024 |
| Certification Date | 04/05/2022 |
| Medicare PECOS PAC ID | 0345393872 |
|---|---|
| Medicare Enrollment ID | O20090731000402 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1073748562 | NPI | - | NPPES |
| 2080303202 | Medicaid | TX |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (NU) | Primary |
| 208000000X | Pediatrics | (NU) | Secondary |
| Provider Name | Fredric C Puckett |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1154596765 PECOS PAC ID: 5890848329 Enrollment ID: I20090731000397 |
| Provider Name | Susan L Hogue |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1609233881 PECOS PAC ID: 3274838008 Enrollment ID: I20160216001983 |
| Provider Name | Lemuel W Kemp |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1184109654 PECOS PAC ID: 0345584231 Enrollment ID: I20181204001118 |
| Provider Name | Lance W Hall |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1992886923 PECOS PAC ID: 5991862310 Enrollment ID: I20200911002590 |
| Provider Name | Heather R Hall |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1407633977 PECOS PAC ID: 2567880412 Enrollment ID: I20231119000028 |
Southwestern Digestive Health Physicians, PA Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 601 S Clay St Ste 108, Ennis, TX 75119 Phone: 972-875-1800 Fax: 972-875-1490 |
Davey M Perrin M.D. Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 206 S Clay St Ste A, Ennis, TX 75119 Phone: 903-229-4292 Fax: 903-229-4288 |
Hope Clinic Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 805 W Lampasas St, Ennis, TX 75119 Phone: 972-923-2440 Fax: 972-923-2445 |
Meg Sullivan, M.D., PA Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 802 W Lampasas St, Ennis, TX 75119 Phone: 972-875-4700 Fax: 972-878-4527 |
Lakewood Hills Internal Medicine, LLC Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 2203 W Lampasas St, Ste 111, Ennis, TX 75119 Phone: 972-875-7770 Fax: 972-875-7775 |
Samuel R Mitz MD PA Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 803 W Lampasas St, Ennis, TX 75119 Phone: 972-875-0546 |