Gene McDaniel DO PA
Organization Active NPI Family Medicine Physician · Springtown, TX
NPI 1730125865 · NPPES record last updated Feb 26, 2013
Key facts
- NPI
- 1730125865
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Family Medicine Physician 207Q00000X
- Legal business name
- GENE MCDANIEL DO PA
- Practice address
- 308 W Hwy 199
Springtown, TX 76082 - Phone
- (817) 523-5402
- Fax
- (817) 523-5422
- NPI assigned
- Jun 20, 2006
- Organization subpart
- No
Authorized official
- Name
- Wendell Gene McDaniel, DO
- Title
- President
- Phone
- (817) 523-5402
Practitioners 6
-
Bobbie Jo Deweese, RN, FNP-C
-
Aimee Lin Simington, NP-C
-
Traci D Huff, APRN-CNP
-
Mauro S Ganzon, MD
-
David C Beam, MD
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in TX
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20051129000185 | TX | Part B Supplier - Clinic/Group Practice | 0143240788 |
Receives reassigned benefits from 4 practitioners Practice locations: Springtown, TX |
National Provider Directory
Locations
628 N Avenue D
Springtown, TX 76082
Phone (817) 523-5402
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician |
207Q00000X | Yes |
Addresses
Primary practice location
308 W Hwy 199
Springtown, TX 76082
Mailing address
PO Box 1039
Springtown, TX 76082
Phone (817) 523-5402
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 80192642 | Other | TX | RR MEDICARE |
| 0093JA | Other | TX | BCBS |
| 154733301 | Medicaid | TX | |
| 4959470001 | Other | TX | DME |
Other providers in Springtown, TX
- DCS Medical PA
- Sarah Krystyn Easter
- Emily Swearingen LCSW PLLC
- Kristen Michelle Estrada
- Ganzon Clinic PA
- Mandy N/a Gibson
- Forrest Duane Giles
- Jamie Elizabeth Greenberg
- Craig Andrew Griebel
- Alan H. Hall
All providers in Springtown, TX · Family Medicine Physician in Texas
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 26, 2013. 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.