Healthcare Provider Details

I. General information

NPI: 1184096273
Provider Name (Legal Business Name): SHACKELFORD COUNTY COMMUNITY RESOURCE CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/28/2015
Last Update Date: 10/28/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

217 EDWARDS
MERKEL TX
79536-3803
US

IV. Provider business mailing address

PO BOX 2435
ALBANY TX
76430-8020
US

V. Phone/Fax

Practice location:
  • Phone: 325-928-0014
  • Fax: 325-925-1175
Mailing address:
  • Phone: 325-762-2447
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State

VIII. Authorized Official

Name: MEAGAN MICHELLE MARSHALL
Title or Position: CFO
Credential:
Phone: 325-762-2447