1275830390 NPI number — CROSS TIMBERS HEALTH CLINICS, INC

Table of content: (NPI 1275830390)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275830390 NPI number — CROSS TIMBERS HEALTH CLINICS, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CROSS TIMBERS HEALTH CLINICS, INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1275830390
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/25/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1100 W REYNOSA AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DE LEON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
76444-1630
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
254-893-5895
Provider Business Mailing Address Fax Number:
866-511-6662

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
135 RIVER NORTH BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
STEPHENVILLE
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76401-1804
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
254-965-2810
Provider Business Practice Location Address Fax Number:
254-965-5440
Provider Enumeration Date:
02/25/2011

Additional Information

Authorized Official

Authorized Official Last Name:
HILL
Authorized Official First Name:
SHERRY
Authorized Official Middle Name:
L.
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
254-893-5895

Provider Taxonomy Codes

  • Taxonomy code: 261QF0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 284574501 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 671963 . This is a "MEDICARE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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