| Short Family Medical Center Pa | |
|
101 Nw Ellison St Burleson TX 76028-4745 | |
| (817) 295-5200 | |
| (817) 295-5210 |
| Full Name | Short Family Medical Center Pa |
|---|---|
| Speciality | Clinic/Center |
| Location | 101 Nw Ellison St, Burleson, Texas |
| Authorized Official Name and Position | Jacky Paul Short (PHYSICIAN) |
| Authorized Official Contact | 8172955200 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Short Family Medical Center Pa 101 Nw Ellison St Burleson TX 76028-4745 Ph: (817) 295-5200 | Short Family Medical Center Pa 101 Nw Ellison St Burleson TX 76028-4745 Ph: (817) 295-5200 |
| NPI Number | 1609172527 |
|---|---|
| Provider Enumeration Date | 02/10/2011 |
| Last Update Date | 02/10/2011 |
| Medicare PECOS PAC ID | 3375883218 |
|---|---|
| Medicare Enrollment ID | O20190313000115 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1609172527 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | K5401 (Texas) | Primary |
| Provider Name | Susan Michelle Short |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1245540137 PECOS PAC ID: 4284974122 Enrollment ID: I20190313000139 |
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