| Sudan Medical Clinic, Llc | |
|
408 E Us Hwy 84 Sudan TX 79371 | |
| (806) 227-2292 | |
| (806) 227-2293 |
| Full Name | Sudan Medical Clinic, Llc |
|---|---|
| Speciality | Physician Assistant |
| Location | 408 E Us Hwy 84, Sudan, Texas |
| Authorized Official Name and Position | Mark Lee Mcclanahan (PRESIDENT/PHYSICIAN) |
| Authorized Official Contact | 8062272292 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Sudan Medical Clinic, Llc Po Box 119 Sudan TX 79371-0119 Ph: (806) 227-2292 | Sudan Medical Clinic, Llc 408 E Us Hwy 84 Sudan TX 79371 Ph: (806) 227-2292 |
| NPI Number | 1215942073 |
|---|---|
| Provider Enumeration Date | 07/30/2006 |
| Last Update Date | 04/12/2021 |
| Medicare PECOS PAC ID | 7618999004 |
|---|---|
| Medicare Enrollment ID | O20051229000131 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1215942073 | NPI | - | NPPES |
| 118927111 | Other | TX | FIRST CARE |
| 00963Z | Other | MEDICARE | |
| 137527 | Other | TX | SUPERIOR HEALTH PLAN |
| 178241901 | Medicaid | TX | |
| 178241902 | Medicaid | TX | |
| 0074NH | Other | TX | BLUE CROSS BLUE SHIELD |
| 673950 | Other | TX | MEDICARE |
| 673951 | Other | TX | MEDICARE |
| 5594300001 | Other | TX | PALMETTO GBA |
| Provider Name | Mark L Mcclanahan |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1750377198 PECOS PAC ID: 0244252633 Enrollment ID: I20051229000144 |
| Provider Name | Erin Jo Gonzales |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1265927545 PECOS PAC ID: 6103174891 Enrollment ID: I20180813003154 |
| Provider Name | Jaysol Eysbet Venzor |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1255054755 PECOS PAC ID: 0244606242 Enrollment ID: I20221017001070 |