Provider Demographics
NPI:1386811958
Name:COMANCHE INTERNAL MEDICINE, PA
Entity type:Organization
Organization Name:COMANCHE INTERNAL MEDICINE, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:HARRY
Authorized Official - Last Name:MCCRANE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:325-641-2655
Mailing Address - Street 1:PO BOX 1825
Mailing Address - Street 2:
Mailing Address - City:BROWNWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:76804-1825
Mailing Address - Country:US
Mailing Address - Phone:325-641-2655
Mailing Address - Fax:325-641-0992
Practice Address - Street 1:10201 HIGHWAY 16
Practice Address - Street 2:
Practice Address - City:COMANCHE
Practice Address - State:TX
Practice Address - Zip Code:76442-4462
Practice Address - Country:US
Practice Address - Phone:254-879-4910
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-13
Last Update Date:2008-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG8185207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX194923201Medicaid
TX00Z206Medicare PIN
TX194923201Medicaid