Organization Name: | VIDOR COMMUNITY HEALTH CLINIC INC |
NPI Number: | 1487669073 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | LINDA J BOONE (PRESIDENT) |
Mailing Address: | 1290 Highway 12 Vidor |
State: | TX US |
Postal Code: | 776624016 |
Phone Number: | 4097697795 |
Fax Number: | 4097698721 |
NPI Enumeration Date: | 07/30/2006 |
NPI Last Update Date: | 02/19/2010 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | 561872 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | TX |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |