Healthcare Provider Details

I. General information

NPI: 1982122115
Provider Name (Legal Business Name): CLARENDON OUTPOST
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/08/2017
Last Update Date: 06/16/2021
Certification Date: 06/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

619 W 2ND ST
CLARENDON TX
79226
US

IV. Provider business mailing address

PO BOX 927
CLARENDON TX
79226-0927
US

V. Phone/Fax

Practice location:
  • Phone: 806-874-5202
  • Fax: 806-874-5204
Mailing address:
  • Phone: 806-874-5202
  • Fax: 806-874-5204

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number16767
License Number StateTX

VIII. Authorized Official

Name: ELMONETTE E BIVENS
Title or Position: PHARMACIST IN CHARGE
Credential:
Phone: 806-874-5202