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Organization
FREDERICKSBURG FAMILY CLINIC PA
Active
Organization
FREDERICKSBURG FAMILY CLINIC PA
Active
Other names
Cornerstone Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
MS. JOHN FOSTER (MANAGER)
(830) 992-2720
Entity
Organization
Contact information
Practice address
514 W WINDCREST ST, FREDERICKSBURG, TX 78624-4633
(830) 997-0330
Mailing address
514 W WINDCREST ST, FREDERICKSBURG, TX 78624-4633
(830) 997-0330
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0009QH
BCBSTX
TX
01
—
189877702
MEDICAID EPSDT
TX
05
—
189877703
—
TX
01
—
DG7779
MEDICARE RAILROAD
TX
Enumeration date
11/13/2006
Last updated
11/18/2019
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