Privia Medical Group West Texas, PLLC
Organization Active NPI Specialist · Abilene, TX
NPI 1346242567 · NPPES record last updated Sep 7, 2022
Key facts
- NPI
- 1346242567
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Specialist 174400000X
- Legal business name
- PRIVIA MEDICAL GROUP WEST TEXAS, PLLC
- Practice address
- 1665 Antilley Rd
# 200
Abilene, TX 79606-5265 - Phone
- (325) 793-5375
- Fax
- (325) 793-5384
- NPI assigned
- Jun 1, 2005
- Organization subpart
- No
Authorized official
- Name
- Andrew Kouba
- Title
- Ceo/Authorized Official
- Phone
- (325) 437-8645
Other NPIs with the same Medicare PAC ID 1
Member organizations 1
Practitioners 167
-
Kathryn Joann Barton, RN, FNP-C
-
Laura L Bennett, M.D.
-
Beil Cory Brown, D.P.M.
-
Patrick Bruton, D.P.M.
-
Zarina M. Calingo, NP-C
-
Peter P. Chang, MD
-
Allison Dallas, FNP-C
-
Jenny Delk-Fikes, MSN, APRN, FNP-C
-
Russell S Dickerson, M.D.
-
Amanda Terpening Duke, MSN, FNP-C
-
Erin Paige Garner, D.O.
-
Teresa Kaye Headstream, F.N.P.
-
Thomas Lee Headstream, M.D.
-
Thomas Randall Hines, M.D.
-
Shannon Hudson, FNP
-
Stephanie Reedy Kinkade, APRN, FNP
-
James B Koch, D.O.
-
Katherine Addie Laws, APRN, FNP-C
-
Krystal Lovelady, FNP
-
Whitney Vannoy Mascorro, M.D.
-
David B McCain, M.D.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in TX
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040604000460 | TX | Part B Supplier - Clinic/Group Practice | 5597747378 | Receives reassigned benefits from 88 practitioners |
National Provider Directory
Locations
1665 Antilley Rd
Ste 2
Abilene, TX 79606
1680 Antilley Rd
Abilene, TX 79606
Phone (325) 428-2900
4225 Woods Pl
Bldg 2
Abilene, TX 79602
Phone (325) 690-0911
1665 Antilley Rd
Ste 285
Abilene, TX 79606
Phone (325) 793-5128
6250 Regional Plz
Ste 1070
Abilene, TX 79606
Phone (325) 232-8540
1680 Antilley Rd
Ste 32
Abilene, TX 79606
1665 Antilley Rd
Ste 205
Abilene, TX 79606
Phone (325) 428-1370
1924 Pine St
Ste 401
Abilene, TX 79601
Phone (325) 670-4242
6771 Memorial Dr
Abilene, TX 79606
Phone (325) 794-5348
1665 Antilley Rd
Ste 280
Abilene, TX 79606
Phone (325) 794-5446
1665 Antilley Rd
Ste 1070
Abilene, TX 79606
6300 Regional Plz
Ste 650
Abilene, TX 79606
Phone (325) 692-5800
1665 Antilley Rd
Ste 290
Abilene, TX 79606
Phone (325) 690-0911
1665 Antilley Rd
Ste A
Abilene, TX 79606
3449 N 10th St
Abilene, TX 79603
Phone (325) 437-8620
6399 Directors Pkwy
Abilene, TX 79606
Phone (325) 573-6374
506 N Judge Ely Blvd
Abilene, TX 79601
140 W 5th St
Baird, TX 79504
Phone (325) 854-1741
1000 E Williams St
Breckenridge, TX 76424
Phone (254) 559-3288
125 S Park Dr
Ste F
Brownwood, TX 76801
Phone (325) 437-2001
4706 N Midkiff Rd
Ste 21
Midland, TX 79705
Phone (432) 256-4525
3000 N Garfield St
Ste 212
Midland, TX 79705
Phone (432) 256-4525
303 W Harris Ave
San Angelo, TX 76903
Phone (325) 949-3860
303 W Harris Ave
Ste 2
San Angelo, TX 76903
Phone (325) 437-8655
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Specialist |
174400000X | Yes |
Addresses
Primary practice location
1665 Antilley Rd
# 200
Abilene, TX 79606-5265
Mailing address
PO Box 5409
Abilene, TX 79608-5409
Phone (325) 437-8655
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1306102-02 | Medicaid | TX |
Other names
- Abilene Diagnostic Clinic, PLLC
Other providers in Abilene, TX
- Sky Jean Prince Shafrin
- Justin Pritchard
- Privia Medical Group West Texas, PLLC
- Privia Medical Group West Texas, PLLC
- Privia Medical Group West Texas, PLLC
- Privia Medical Group West Texas, PLLC
- Privia Medical Group West Texas, PLLC
- Privia Medical Group West Texas, PLLC
- Privia Medical Group West Texas, PLLC
- Christopher William Proctor
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 7, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.