Provider Demographics
NPI:1942464334
Name:KERRVILLE MEC, LP
Entity type:Organization
Organization Name:KERRVILLE MEC, LP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:R
Authorized Official - Last Name:WALKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:325-694-4500
Mailing Address - Street 1:280 N BUSINESS 35
Mailing Address - Street 2:STE 300
Mailing Address - City:NEW BRAUNFELS
Mailing Address - State:TX
Mailing Address - Zip Code:78130-7807
Mailing Address - Country:US
Mailing Address - Phone:830-629-2273
Mailing Address - Fax:830-629-9675
Practice Address - Street 1:280 N BUSINESS 35
Practice Address - Street 2:STE 300
Practice Address - City:NEW BRAUNFELS
Practice Address - State:TX
Practice Address - Zip Code:78130-7807
Practice Address - Country:US
Practice Address - Phone:830-629-2273
Practice Address - Fax:830-629-9675
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:KERRVILLE MEC, LP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-07-15
Last Update Date:2008-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center