Healthcare Provider Details

I. General information

NPI: 1346221868
Provider Name (Legal Business Name): THE EAGLE FORD CLINICS, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/10/2005
Last Update Date: 10/29/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

325 N CHERRY ST
PEARSALL TX
78061-2509
US

IV. Provider business mailing address

111 E MILLER ST
DILLEY TX
78017-3912
US

V. Phone/Fax

Practice location:
  • Phone: 830-334-8703
  • Fax: 830-334-5792
Mailing address:
  • Phone: 830-965-1684
  • Fax: 830-965-1278

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: SURESH DUTTA
Title or Position: OWNER
Credential: MD
Phone: 830-965-1684