Provider Demographics
NPI:1265022404
Name:A1 HEALTH CLINIC LLC
Entity type:Organization
Organization Name:A1 HEALTH CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TIFFANY
Authorized Official - Middle Name:M
Authorized Official - Last Name:LARNETTE
Authorized Official - Suffix:
Authorized Official - Credentials:FNP-C
Authorized Official - Phone:409-333-1257
Mailing Address - Street 1:2855 EASTEX FWY STE I
Mailing Address - Street 2:
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77706-3065
Mailing Address - Country:US
Mailing Address - Phone:409-333-1242
Mailing Address - Fax:409-333-1257
Practice Address - Street 1:2855 EASTEX FWY STE I
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77706-3065
Practice Address - Country:US
Practice Address - Phone:409-333-1242
Practice Address - Fax:409-333-1257
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-21
Last Update Date:2023-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1669829560OtherNPI