Provider Demographics
NPI:1538417936
Name:FALFURRIAS MEMORIAL MEDICAL CLINIC LLC
Entity type:Organization
Organization Name:FALFURRIAS MEMORIAL MEDICAL CLINIC LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:DAYANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:SAUCEDA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:361-667-3034
Mailing Address - Street 1:118 FLACK ST
Mailing Address - Street 2:
Mailing Address - City:FALFURRIAS
Mailing Address - State:TX
Mailing Address - Zip Code:78355-4930
Mailing Address - Country:US
Mailing Address - Phone:361-667-3034
Mailing Address - Fax:361-667-3037
Practice Address - Street 1:118 FLACK ST
Practice Address - Street 2:
Practice Address - City:FALFURRIAS
Practice Address - State:TX
Practice Address - Zip Code:78355-4930
Practice Address - Country:US
Practice Address - Phone:361-667-3034
Practice Address - Fax:361-667-3037
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-16
Last Update Date:2012-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH8375207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXH8375OtherLICENSE