Cornelia L Agent MD PA
Organization Active NPI Internal Medicine Physician · Alvin, TX
NPI 1831473354 · NPPES record last updated Oct 3, 2011
Key facts
- NPI
- 1831473354
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Internal Medicine Physician 207R00000X
- License
- F9123 (TX)
- Legal business name
- CORNELIA L AGENT MD PA
- Practice address
- 215 W Blackstone LN
Alvin, TX 77511-3407 - Phone
- (281) 331-5253
- Fax
- (281) 585-4074
- NPI assigned
- Oct 3, 2011
- Organization subpart
- No
Authorized official
- Name
- Cornelia L Agent, MD
- Title
- Owner
- Phone
- (281) 331-5253
Practitioners 6
-
Cornelia Louise Agent, M.D. P.A.
-
Eileen Francis, PA
-
Mark Hooker, M.D.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in TX
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20120531000584 | TX | Part B Supplier - Clinic/Group Practice | 8820251887 |
Receives reassigned benefits from 1 practitioner Practice locations: Alvin, TX; La Marque, TX; Texas City, TX |
National Provider Directory
Locations
215 W Blackstone Ln
Alvin, TX 77511
Phone (281) 331-5253
3820 Mustang Rd
Laurel CT
Alvin, TX 77511
Phone (281) 824-0070
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician |
207R00000X | F9123 | TX | Yes |
Addresses
Primary practice location
215 W Blackstone LN
Alvin, TX 77511-3407
Mailing address
215 W Blackstone LN
Alvin, TX 77511-3407
Phone (281) 331-5253
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 114075801 | Medicaid | TX |
Other providers in Alvin, TX
- Clyde Vision, PLLC
- Levi Lee Clyde
- Coastal Eye Associates, PLLC
- Joanna Catherine Cobb
- Anita Coleman
- Suzanne Marie Correale
- Kristi Crain
- Domonick F Crane
- Aishah L. Crosley
- Gail L Cunningham
All providers in Alvin, TX · Internal 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 Oct 3, 2011. 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.