Privia Medical Group West Texas, PLLC

Primary specialty

PodiatristTaxonomy code 213E00000X

Legal business name

PRIVIA MEDICAL GROUP WEST TEXAS, PLLC

Doing business as

Abilene Diagnostic Clinics

Practice address

6250 Regional PLZ Ste 1016
Abilene, TX 79606-5223

Phone

(325) 437-8655

Fax

(325) 437-8647

NPI assigned

Mar 25, 2009

Last updated

Jul 25, 2022By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Andrew Kouba

Title

Ceo/Authorized Official

Phone

(325) 437-8645

Specialties & licenses 1

Addresses

Other names 3

• Abilene Diagnostic Clinics Doing business as
• Abilene Diagnostic Clinic, PLLC Former legal business name
• Podiatry DME Suite 1016 Other name

Member organizations 1

Organizations listed as members of this organization in the National Provider Directory.

• Armc LP

  dba Abilene Regional Medical Center

  • General Acute Care Hospital
  • Abilene, TX
  • NPI 1851344162

  Member Of

  NPD member

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1237939200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658707200000",
    "number": "1013159854",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 5409",
            "city": "ABILENE",
            "state": "TX",
            "postal_code": "796085409",
            "telephone_number": "325-437-8655",
            "fax_number": "325-437-8647"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6250 REGIONAL PLZ STE 1016",
            "city": "ABILENE",
            "state": "TX",
            "postal_code": "796065223",
            "telephone_number": "325-437-8655",
            "fax_number": "325-437-8647"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRIVIA MEDICAL GROUP WEST TEXAS, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-03-25",
        "last_updated": "2022-07-25",
        "certification_date": "2022-07-25",
        "status": "A",
        "authorized_official_last_name": "KOUBA",
        "authorized_official_first_name": "ANDREW",
        "authorized_official_title_or_position": "CEO/AUTHORIZED OFFICIAL",
        "authorized_official_telephone_number": "325-437-8645"
    },
    "taxonomies": [
        {
            "code": "213E00000X",
            "taxonomy_group": "",
            "desc": "Podiatrist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Abilene Diagnostic Clinics",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Abilene Diagnostic Clinic, PLLC",
            "code": "4",
            "type": "Former Legal Business Name"
        },
        {
            "organization_name": "Podiatry DME Suite 1016",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Michael Dewayne Price, M.D.
• Leddy McCall Priddy, PT, DPT
• Primary Nurse Care, Inc (Elara Caring)
• Prime Care Anesthesia, PLLC
• Sky Jean Prince Shafrin
• Privia Medical Group West Texas, PLLC (Abilene Diagnostic Clinics)
• Privia Medical Group West Texas, PLLC
• Privia Medical Group West Texas, PLLC (Abilene Diagnostic Clinic, PLLC)
• Privia Medical Group West Texas, PLLC
• Privia Medical Group West Texas, PLLC

• Podiatrist in Abilene, TX
• Providers in Abilene, TX by specialty
• Podiatrist in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 25, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.