| Organization Name: | LAKE TEXOMA HEALTH CLINIC, PLLC |
| NPI Number: | 1871929737 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | DEBORAH LYNN BURCHFIELD (OWNER) |
| Mailing Address: | 81750 N State Hwy 289 Suite 101 Pottsboro |
| State: | TX US |
| Postal Code: | 75076 |
| Phone Number: | 9033575014 |
| Fax Number: | 8668238694 |
| NPI Enumeration Date: | 09/23/2013 |
| NPI Last Update Date: | 01/13/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QP2300X |
| License Number: | 583252 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | TX |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Primary Care |
| Taxonomy Definition: | |