Healthcare Provider Details

I. General information

NPI: 1639340748
Provider Name (Legal Business Name): COUNTY OF CLAY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/17/2008
Last Update Date: 11/20/2025
Certification Date: 11/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310 W SOUTH ST
HENRIETTA TX
76365-3346
US

IV. Provider business mailing address

310 W SOUTH ST
HENRIETTA TX
76365-3346
US

V. Phone/Fax

Practice location:
  • Phone: 940-235-1202
  • Fax: 940-235-1215
Mailing address:
  • Phone: 940-235-1202
  • Fax: 940-235-1215

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number00193
License Number StateTX

VIII. Authorized Official

Name: BOB STEVEN ELLZEY
Title or Position: INTERIM CEO
Credential:
Phone: 940-235-1200