Privia Medical Group West Texas, PLLC
Specialist in Abilene, TX. Organization (NPI-2).
NPI number1346242567
StatusActive
Last updated in NPPESSep 7, 2022
Details
- NPI
- 1346242567
- Entity type
- Organization (NPI-2)
- Legal business name
- Privia Medical Group West Texas, PLLC
- Organization subpart
- No
- Enumeration date
- Jun 1, 2005
- Certification date
- Sep 7, 2022
- Last updated
- Sep 7, 2022
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 174400000X | Specialist | – | – | Yes |
Other names
- Abilene Diagnostic Clinic, PLLC (Doing Business As)
Practice location
1665 Antilley Rd# 200
Abilene, TX 79606-5265
Phone 325-793-5375 · Fax 325-793-5384
Mailing address
Po Box 5409Abilene, TX 79608-5409
Phone 325-437-8655 · Fax 325-437-8647
Authorized official
Andrew Kouba
Ceo/Authorized Official
3254378645
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