Organization Name: | EASTLAND HEALTH CLINIC PLLC |
NPI Number: | 1942572227 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | JULIE BERENDA STEWART (FAMILY NURSE PRACTITIONER) |
Mailing Address: | 1004 W Main St Eastland |
State: | TX US |
Postal Code: | 764482432 |
Phone Number: | 2546310111 |
Fax Number: | 2546310186 |
NPI Enumeration Date: | 02/02/2012 |
NPI Last Update Date: | 05/03/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QP2300X |
License Number: | 653723 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | TX |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Primary Care |
Taxonomy Definition: |