| Lockhart Family Practice Center | |
|
2060 S Colorado St Lockhart TX 78644-3951 | |
| (512) 398-9610 | |
| Not Available |
| Full Name | Lockhart Family Practice Center |
|---|---|
| Speciality | Clinic/Center |
| Location | 2060 S Colorado St, Lockhart, Texas |
| Authorized Official Name and Position | Rafael De La Paz (CEO) |
| Authorized Official Contact | 8306726511 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Lockhart Family Practice Center Po Box 1890 Gonzales TX 78629-1390 Ph: (830) 672-6511 | Lockhart Family Practice Center 2060 S Colorado St Lockhart TX 78644-3951 Ph: (512) 398-9610 |
| NPI Number | 1063894855 |
|---|---|
| Provider Enumeration Date | 06/29/2015 |
| Last Update Date | 09/03/2020 |
| Medicare PECOS PAC ID | 4688650328 |
|---|---|
| Medicare Enrollment ID | O20151029002074 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1063894855 | NPI | - | NPPES |
| 355594801 | Medicaid | TX |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
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