Organization
TEJAS HEALTH CARE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PAMELA WYANT (BILLING SUPERVISOR)
(979) 968-2000
Entity
Organization
Contact information
Practice address
890 E TRAVIS ST, LA GRANGE, TX 78945-2364
(979) 968-2000
(979) 968-2001
Mailing address
753 E TRAVIS ST, LA GRANGE, TX 78945-2353
(979) 968-2000
(979) 968-2001
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
—
—
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
202580104
—
TX
05
—
202580107
—
TX
05
—
202580110
—
TX
Enumeration date
08/04/2008
Last updated
05/07/2019
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