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PRIVIA MEDICAL GROUP WEST TEXAS PLLC NPI 1346242567


NPI Information

NPI: 1346242567
Provider Name: PRIVIA MEDICAL GROUP WEST TEXAS, PLLC

Doing Business As: ABILENE DIAGNOSTIC CLINIC, PLLC

Classification: Specialist - 174400000X
Entity Type: Organization

CLIA Number: 45D2136253

Address:
1665 ANTILLEY RD
# 200
ABILENE, TX
ZIP 79606
Phone: (325) 793-5375
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PRIVIA MEDICAL GROUP WEST TEXAS, PLLC is a specialist in Abilene, TX. The provider is an individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. PRIVIA MEDICAL GROUP WEST TEXAS, PLLC NPI is 1346242567. The provider is registered as an organization entity type and is a multi-specialty group.
The provider Is Doing Business As Abilene Diagnostic Clinic, Pllc.

The provider's business location address is:

1665 ANTILLEY RD
# 200
ABILENE, TX
ZIP 79606-265
Phone: (325) 793-5375
Fax: (325) 793-5384

The provider's authorized official is Andrew Kouba .
The authorized official title is Ceo/authorized Official and has the following contact phone number (325) 437-8645.

The CLIA number assigned to this NPI record is 45D2136253 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 6/1/2005 and was last updated on 9/7/2022.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1174400000XSpecialistYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
11306102-02MEDICAIDTEXAS

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.