| Southwest Anti-aging Center | |
|
5701 Time Square Blvd Ste 220 Amarillo TX 79119-1178 | |
| (806) 350-7311 | |
| (806) 350-7361 |
| Full Name | Southwest Anti-aging Center |
|---|---|
| Speciality | Internal Medicine |
| Location | 5701 Time Square Blvd Ste 220, Amarillo, Texas |
| Authorized Official Name and Position | Kathleen Anne Clark (MD) |
| Authorized Official Contact | 8063507311 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Southwest Anti-aging Center 5701 Time Square Blvd Ste 220 Amarillo TX 79119-1178 Ph: (806) 350-7311 | Southwest Anti-aging Center 5701 Time Square Blvd Ste 220 Amarillo TX 79119-1178 Ph: (806) 350-7311 |
| NPI Number | 1083085385 |
|---|---|
| Provider Enumeration Date | 10/13/2015 |
| Last Update Date | 11/09/2017 |
| Medicare PECOS PAC ID | 1355609736 |
|---|---|
| Medicare Enrollment ID | O20171212000986 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1083085385 | NPI | - | NPPES |
| 1083085385 | Other | TX | NPI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | P8871 (Texas) | Primary |
| Provider Name | Kathleen A Clark |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1518103886 PECOS PAC ID: 5294890414 Enrollment ID: I20090223000077 |
| Provider Name | Christi Ann Rogers |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1073091914 PECOS PAC ID: 5395084891 Enrollment ID: I20190227002788 |
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