Full Name | |
---|---|
Speciality | Clinic/center - Rural Health |
Location | 157 Wall St, Tenaha, Texas |
Authorized Official Name and Position | Jean Youngstrom Diebolt (CEO) |
Authorized Official Contact | 9362484673 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
---|---|
157 Wall St Tenaha TX 75974-5413 Ph: (936) 248-4673 | 157 Wall St Tenaha TX 75974-5413 Ph: (936) 248-4673 |
NPI Number | 1356468300 |
---|---|
Provider Enumeration Date | 03/23/2007 |
Last Update Date | 06/24/2022 |
Identifier | Type | State | Issuer |
---|---|---|---|
1356468300 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QR1300X | Clinic/center - Rural Health | 261QR1300X (Texas) | Primary |