Organization Name: | TCH FAMILY PRACTICE CLINIC |
NPI Number: | 1407186950 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | BETTY HOLTON (OFFICE MANAGER) |
Mailing Address: | 104 N Beech St Woodville |
State: | TX US |
Postal Code: | 759794718 |
Phone Number: | 4092832822 |
Fax Number: | 4092837852 |
NPI Enumeration Date: | 01/06/2010 |
NPI Last Update Date: | 01/06/2010 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QR1300X |
License Number: | 608112 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | TX |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Rural Health |
Taxonomy Definition: |