| Organization Name: | FAMILY MEDICINE RURAL HEALTH CLINIC |
| NPI Number: | 1003195165 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | RICHARD L INGRIM (OWNER) |
| Mailing Address: | 801 N Waldrip St Suite B Grand Saline |
| State: | TX US |
| Postal Code: | 751401024 |
| Phone Number: | 9039627551 |
| Fax Number: | 9039627122 |
| NPI Enumeration Date: | 08/08/2011 |
| NPI Last Update Date: | 08/08/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QR1300X |
| License Number: | G7239 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | TX |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Rural Health |
| Taxonomy Definition: | |