Provider Demographics
NPI:1861488694
Name:ANDREWS COUNTY
Entity type:Organization
Organization Name:ANDREWS COUNTY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:LYNNE
Authorized Official - Last Name:MCCULLOUGH
Authorized Official - Suffix:
Authorized Official - Credentials:ADVANCED PN
Authorized Official - Phone:432-524-1434
Mailing Address - Street 1:208 NW 2ND ST
Mailing Address - Street 2:
Mailing Address - City:ANDREWS
Mailing Address - State:TX
Mailing Address - Zip Code:79714-6308
Mailing Address - Country:US
Mailing Address - Phone:432-524-1434
Mailing Address - Fax:432-524-1461
Practice Address - Street 1:208 NW 2ND ST
Practice Address - Street 2:
Practice Address - City:ANDREWS
Practice Address - State:TX
Practice Address - Zip Code:79714-6308
Practice Address - Country:US
Practice Address - Phone:432-524-1434
Practice Address - Fax:432-524-1461
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-27
Last Update Date:2010-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX094701202Medicaid
TX063303402Medicaid
TX094701201Medicaid
TX017486401Medicaid
TX094701203Medicaid
TX094701201Medicaid