Provider Demographics
NPI:1942363916
Name:WEST OAK MEDICAL CLINIC PA
Entity Type:Organization
Organization Name:WEST OAK MEDICAL CLINIC PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:MR
Authorized Official - First Name:BILLY
Authorized Official - Middle Name:D
Authorized Official - Last Name:PIERCE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:254-826-3865
Mailing Address - Street 1:407 W OAK ST
Mailing Address - Street 2:PO BOX 458
Mailing Address - City:WEST
Mailing Address - State:TX
Mailing Address - Zip Code:76691-1427
Mailing Address - Country:US
Mailing Address - Phone:254-826-3865
Mailing Address - Fax:254-826-7071
Practice Address - Street 1:407 W OAK ST
Practice Address - Street 2:
Practice Address - City:WEST
Practice Address - State:TX
Practice Address - Zip Code:76691-1427
Practice Address - Country:US
Practice Address - Phone:254-826-3865
Practice Address - Fax:254-826-7071
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-19
Last Update Date:2008-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00X869Medicare PIN