Provider Demographics
NPI:1922189893
Name:LINETTE B. MELCHER, MD PA
Entity Type:Organization
Organization Name:LINETTE B. MELCHER, MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LINETTE
Authorized Official - Middle Name:B
Authorized Official - Last Name:MELCHER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:830-257-3669
Mailing Address - Street 1:712 HILL COUNTRY DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:KERRVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78028-6165
Mailing Address - Country:US
Mailing Address - Phone:830-257-3669
Mailing Address - Fax:830-895-1147
Practice Address - Street 1:712 HILL COUNTRY DR
Practice Address - Street 2:SUITE 100
Practice Address - City:KERRVILLE
Practice Address - State:TX
Practice Address - Zip Code:78028-6165
Practice Address - Country:US
Practice Address - Phone:830-257-3669
Practice Address - Fax:830-895-1147
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-18
Last Update Date:2010-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ9524174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0009PYOtherBCBS
TX031481701Medicaid
TX031481701Medicaid
TX00X759Medicare PIN
TX0009PYOtherBCBS