| Organization Name: | SHACKELFORD COUNTY COMMUNITY RESOURCE CENTER |
| NPI Number: | 1881985299 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | TINA LOUISE BETCHER (BILLING MANAGER/CREDENTIALER) |
| Mailing Address: | 301 S Main St Cross Plains |
| State: | TX US |
| Postal Code: | 764432581 |
| Phone Number: | 2547254311 |
| Fax Number: | 2547254313 |
| NPI Enumeration Date: | 04/20/2011 |
| NPI Last Update Date: | 09/17/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QF0400X |
| License Number: | 30117281979 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | TX |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Federally Qualified Health Center (FQHC) |
| Taxonomy Definition: | |