| Wallace Mann MD PA | |
|
202 S Mcgee St Borger TX 79007-4022 | |
| (806) 273-7118 | |
| (806) 274-6070 |
| Full Name | Wallace Mann MD PA |
|---|---|
| Speciality | Family Medicine |
| Location | 202 S Mcgee St, Borger, Texas |
| Authorized Official Name and Position | Wallace Mann (OWNER CEO) |
| Authorized Official Contact | 8062737118 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Wallace Mann MD PA 202 S Mcgee St Borger TX 79007-4022 Ph: (806) 273-7118 | Wallace Mann MD PA 202 S Mcgee St Borger TX 79007-4022 Ph: (806) 273-7118 |
| NPI Number | 1437352770 |
|---|---|
| Provider Enumeration Date | 06/06/2007 |
| Last Update Date | 05/13/2024 |
| Certification Date | 05/13/2024 |
| Medicare PECOS PAC ID | 6800927047 |
|---|---|
| Medicare Enrollment ID | O20100701000457 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1437352770 | NPI | - | NPPES |
| 111983601 | Medicaid | TX | |
| 111983603 | Medicaid | TX |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | K6771 (Texas) | Primary |
| Provider Name | Wallace H Mann |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1326036856 PECOS PAC ID: 6507923620 Enrollment ID: I20090317000392 |
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