Healthcare Provider Details

I. General information

NPI: 1487886966
Provider Name (Legal Business Name): PANHANDLE FAMILY CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/17/2009
Last Update Date: 02/10/2021
Certification Date: 02/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 HWY 60 E
PANHANDLE TX
79068
US

IV. Provider business mailing address

PO BOX 10
PANHANDLE TX
79068-0010
US

V. Phone/Fax

Practice location:
  • Phone: 806-532-2273
  • Fax: 806-532-2276
Mailing address:
  • Phone: 806-532-2273
  • Fax: 806-532-2276

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number648580
License Number StateTX

VIII. Authorized Official

Name: HOLLY L JEFFREYS
Title or Position: ADMINISTRATOR
Credential:
Phone: 806-532-2273