Provider Demographics
NPI:1730622432
Name:SABINE-NECHES FAMILY CLINIC LLC
Entity type:Organization
Organization Name:SABINE-NECHES FAMILY CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:KRISTI
Authorized Official - Middle Name:
Authorized Official - Last Name:COLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:409-276-2067
Mailing Address - Street 1:PO BOX 599
Mailing Address - Street 2:1017 FM 105
Mailing Address - City:EVADALE
Mailing Address - State:TX
Mailing Address - Zip Code:77615-0599
Mailing Address - Country:US
Mailing Address - Phone:409-276-2067
Mailing Address - Fax:
Practice Address - Street 1:1017 FM 105
Practice Address - Street 2:
Practice Address - City:EVADALE
Practice Address - State:TX
Practice Address - Zip Code:77615-0599
Practice Address - Country:US
Practice Address - Phone:409-276-2067
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-29
Last Update Date:2017-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty