Provider Demographics
NPI:1831479948
Name:ACCESS MD HEALTHCARE GROUP, PLLC
Entity Type:Organization
Organization Name:ACCESS MD HEALTHCARE GROUP, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING SPECIALISTS
Authorized Official - Prefix:
Authorized Official - First Name:ALICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:PEPPER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:806-651-9680
Mailing Address - Street 1:4905 LEXINGTON SQ
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79119-6574
Mailing Address - Country:US
Mailing Address - Phone:806-350-7569
Mailing Address - Fax:806-353-6707
Practice Address - Street 1:4905 LEXINGTON SQ
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79119-6574
Practice Address - Country:US
Practice Address - Phone:806-350-7569
Practice Address - Fax:806-353-6707
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-19
Last Update Date:2014-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX297752201Medicaid
TXTXB137839Medicare PIN