| Shackelford County Community Resource Center | |
|
1712 North Access Road Clyde TX 79510 | |
| (325) 893-4010 | |
| (325) 893-4035 |
| Full Name | Shackelford County Community Resource Center |
|---|---|
| Speciality | Clinic/Center |
| Location | 1712 North Access Road, Clyde, Texas |
| Authorized Official Name and Position | Tina Louise Betcher (BILLING MANAGER/CREDENTIALER) |
| Authorized Official Contact | 3258934010 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Shackelford County Community Resource Center Po Box 2435 Albany TX 76430-8020 Ph: (325) 762-2447 | Shackelford County Community Resource Center 1712 North Access Road Clyde TX 79510 Ph: (325) 893-4010 |
| NPI Number | 1215205265 |
|---|---|
| Provider Enumeration Date | 12/06/2011 |
| Last Update Date | 10/30/2012 |
| Medicare PECOS PAC ID | 8628027174 |
|---|---|
| Medicare Enrollment ID | O20120131000925 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1215205265 | NPI | - | NPPES |
| 287755701 | Medicaid | TX |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | 30117281979 (Texas) | Primary |
Callahan County Health And Wellness Clinic Pllc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 102 Archer St, Clyde, TX 79510 Phone: 325-893-1010 |