| Granbury Family Med Clinic | |
|
805 Hill Blvd Suite 103 Granbury TX 76048-1482 | |
| (817) 573-3447 | |
| Not Available |
| Full Name | Granbury Family Med Clinic |
|---|---|
| Speciality | Clinic/Center |
| Location | 805 Hill Blvd, Granbury, Texas |
| Authorized Official Name and Position | Robert Louis Lee (OWNER) |
| Authorized Official Contact | 8175733447 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Granbury Family Med Clinic 805 Hill Blvd Suite 103 Granbury TX 76048-1481 Ph: (817) 573-3447 | Granbury Family Med Clinic 805 Hill Blvd Suite 103 Granbury TX 76048-1482 Ph: (817) 573-3447 |
| NPI Number | 1396934147 |
|---|---|
| Provider Enumeration Date | 10/17/2007 |
| Last Update Date | 03/03/2008 |
| Medicare PECOS PAC ID | 2769498005 |
|---|---|
| Medicare Enrollment ID | O20060223000834 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1396934147 | NPI | - | NPPES |
| 145044701 | Medicaid | TX |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Primary |
| Provider Name | Robert L Lee |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1366537482 PECOS PAC ID: 6204842545 Enrollment ID: I20100630000564 |
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