Organization Name: | SHACKELFORD COUNTY COMMUNITY RESOURCE CENTER |
NPI Number: | 1437551710 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | DUSTIN T HAWK (CEO) |
Mailing Address: | 200 N Main St Cross Plains |
State: | TX US |
Postal Code: | 764433312 |
Phone Number: | 2547257330 |
Fax Number: | |
NPI Enumeration Date: | 09/18/2014 |
NPI Last Update Date: | 10/21/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QF0400X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Federally Qualified Health Center (FQHC) |
Taxonomy Definition: |