| Organization Name: | EDMONDSON ROSS & HURST MEMORIAL CLINIC PLLC |
| NPI Number: | 1033376744 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | KEVIN BRENT STACKS (SOLE MEMBER) |
| Mailing Address: | 600 N Highland Ave Suite 105 Sherman |
| State: | TX US |
| Postal Code: | 750925631 |
| Phone Number: | 9038922781 |
| Fax Number: | 9038922780 |
| NPI Enumeration Date: | 05/20/2008 |
| NPI Last Update Date: | 03/15/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | K7908 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | TX |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |