Organization
PRIVIA MEDICAL GROUP WEST TEXAS, PLLC
Active
Other names
Abilene Diagnostic Clinic, PLLC, Podiatry DME Suite 1016, Abilene Diagnostic Clinics
Organization subpart
No
Provider details
NPI number
Authorized official
ANDREW KOUBA (CEO/AUTHORIZED OFFICIAL)
(325) 437-8645
Entity
Organization
Contact information
Practice address
6250 REGIONAL PLZ STE 1016, ABILENE, TX 79606-5223
(325) 437-8655
(325) 437-8647
Mailing address
PO BOX 5409, ABILENE, TX 79608-5409
(325) 437-8655
(325) 437-8647
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
—
—
Other
Enumeration date
03/25/2009
Last updated
07/25/2022
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