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Organization

PILOT POINT MEDICAL CLINIC, P.A.

Active
Other names
Kenneth W. Beresford, M.D., P.A.
Organization subpart
No

Provider details

NPI number
Authorized official
DR. KENNETH WAYNE BERESFORD M.D. (OWNER)
(940) 686-2254
Entity
Organization

Contact information

Practice address
1246 S HIGHWAY 377, PILOT POINT, TX 76258-4375
(940) 686-2254
(940) 686-2830
Mailing address
PO BOX 1117, 1246 HWY 377 SOUTH SUITE 200, PILOT POINT, TX 76258-1117
(940) 686-2254
(940) 686-2830

Taxonomy

Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
K9226
TX

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
045386202
TX
01
0A3440
MEDICARE GROUP PTAN
TX
01
0A3440
MEDICARE INDIVID PTAN FOR GRP NPI
01
8F20689
MEDICARE INDIV PTAN INDVID NPI
TX
Enumeration date
07/23/2006
Last updated
01/12/2012
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