| Organization Name: | STAFFORD COMMUNITY CLINIC, LLC |
| NPI Number: | 1063557064 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | AGUEDA LARA-SMALLING (ADMINISTRATOR) |
| Mailing Address: | 13004 Murphy Rd Suite 224 Stafford |
| State: | TX US |
| Postal Code: | 774773971 |
| Phone Number: | 2817770599 |
| Fax Number: | |
| NPI Enumeration Date: | 02/20/2007 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QH0100X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | X |
| State: | |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Health Service |
| Taxonomy Definition: | |