Unknown Individual – General Practice Physician, NPI 1366632580

General Practice Physician

Unknown Individual is a healthcare provider. based in Killeen, Texas. specializing in General Practice Physician. They hold a License No. J0696 (TX). The NPI Number for Unknown Individual is 1366632580

Main info

Organization

Inactive

49 Years Of Experience

Accepts Medicare Assignment

Name

Unknown Individual

NPI

1366632580

Phone

(855) 963-4325

Address

2300 S CLEAR CREEK RD

Deactivation Date

21 June 2021

Doctor Profile

Medical School Name

OTHER

Secondary Phone

8559634325

Graduation Year

1977 (49 years ago)

PAC ID

5991795643

Group Practice PAC ID

7012089147

Professional Enrollment ID

I20040514000311

Data current as of

19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology

Experience14

Completeness75

Years active:0State licenses:1Digital endpointsOther names

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Provider Addresses for Unknown Individual

South Clear Creek Road, Killeen, Bell County, Texas, 76549, United States
SUITE 101
KILLEEN, TX 765494984
Phone: (855) 963-4325
Fax: (855) 963-4325
Mailing address matches the actual address.

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

No Open Payments data available for this provider.

This can happen when there are no reportable CMS Open Payments records.

Medicare Enrollment & Revalidation

Source: CMS public data · Not endorsed by CMS ·

Educational use only—not medical, billing, or legal advice.

No Medicare enrollment or revalidation data available for this provider in our database.

Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS

Medicare Utilization (FFS)

Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·

Educational use only—not medical, billing, or legal advice.

No Medicare fee-for-service utilization data available for this provider in our database.

Insurance plans in this area (ZIP 76549)

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Group practice members

Group practice members are other physicians who share the same Group Practice PAC ID with this doctor. When doctors form a group practice and register in PECOS as a single entity, they receive a shared identification number. This table lists all providers in the same group practice.

PAC ID: 7012089147View full group profile