NPI age
19 years
Enumerated 2006-11-02
Across 1335 active clinic/center providers in Texas.
| Type | Value | Notes |
|---|---|---|
| 01 (TX) | 3837LC | BLUE CROSS BLUE SHIELD |
| 01 (TX) | 10012627 | AMERIGROUP |
| 05 (TX) | 027960601 |
Doing-business-as, former, and alternate names recorded by NPPES.
Single-site organization. Only one practice location on file.
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