Provider Demographics
NPI:1750501417
Name:NOCONA MEDICAL CLINIC, P.A.
Entity Type:Organization
Organization Name:NOCONA MEDICAL CLINIC, P.A.
Other - Org Name:BOWIE MEDICAL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LEONARD
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:DINGLER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:940-825-3333
Mailing Address - Street 1:90 PARK RD
Mailing Address - Street 2:
Mailing Address - City:NOCONA
Mailing Address - State:TX
Mailing Address - Zip Code:76255-3600
Mailing Address - Country:US
Mailing Address - Phone:940-825-3333
Mailing Address - Fax:940-825-3052
Practice Address - Street 1:90 PARK RD
Practice Address - Street 2:
Practice Address - City:NOCONA
Practice Address - State:TX
Practice Address - Zip Code:76255-3600
Practice Address - Country:US
Practice Address - Phone:940-825-3333
Practice Address - Fax:940-825-3052
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-26
Last Update Date:2024-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00D971OtherBCBS
TX0821407-04Medicaid
TX0821407-01Medicaid
TX0821407-02Medicaid
TX0944720-02Medicaid
TX453876Medicare ID - Type UnspecifiedRHC MEDICARE
TX673801Medicare ID - Type UnspecifiedRHC MEDICARE ST JO
TX0821407-04Medicaid