Shepherd Rural Health Clinic PA
Organization Active NPI Physician Assistant · Shepherd, TX
NPI 1376629212 · NPPES record last updated Aug 30, 2010
Key facts
- NPI
- 1376629212
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Physician Assistant 363A00000X
- License
- F4703 (TX)
- Legal business name
- SHEPHERD RURAL HEALTH CLINIC PA
- Practice address
- 11 Woodland Park Drive
Shepherd, TX 77371 - Phone
- (936) 628-3343
- NPI assigned
- Oct 31, 2006
- Organization subpart
- No
Authorized official
- Name
- Dr. Philip R Wisiackas, MD
- Title
- Physician
- Phone
- (936) 628-3343
Practitioners 1
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant |
363A00000X | F4703 | TX | Yes |
Addresses
Primary practice location
11 Woodland Park Drive
Shepherd, TX 77371
Mailing address
PO Box 669
Shepherd, TX 77371-0669
Phone (936) 628-3343
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 130767003 | Medicaid | TX |
Other providers in Shepherd, TX
- PNV Creative Care, Inc
- Gendaraneshy Rodriguez
- Emily Sheffield
- Shepherd I S D
- Shepherd Isd
- Christina Rochelle Shrader
- Samantha Sublett
- Krishawna Mund Thompson
- Kimberly Yvette Romona Nicole Truitt
- Chelsea Nicole Williams
All providers in Shepherd, TX · Physician Assistant in Texas
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 30, 2010. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.