1750573416 NPI number — SLATON FAMILY MEDICAL, PLLC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750573416 NPI number — SLATON FAMILY MEDICAL, PLLC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SLATON FAMILY MEDICAL, PLLC.
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:
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:
1750573416
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/07/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 54136
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LUBBOCK
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
79453-4136
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
806-771-1386
Provider Business Mailing Address Fax Number:
806-771-1388

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
235 W GARZA ST
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
SLATON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
79364-4127
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
806-828-1600
Provider Business Practice Location Address Fax Number:
806-828-1610
Provider Enumeration Date:
08/15/2007

Additional Information

Authorized Official

Authorized Official Last Name:
BENDECK
Authorized Official First Name:
AL
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
806-828-1600

Provider Taxonomy Codes

  • Taxonomy code: 261QR1300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 210889601 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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