Healthcare Provider Details

I. General information

NPI: 1750573416
Provider Name (Legal Business Name): SLATON FAMILY MEDICAL, PLLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/15/2007
Last Update Date: 08/07/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

235 W GARZA ST SUITE B
SLATON TX
79364-4127
US

IV. Provider business mailing address

PO BOX 54136
LUBBOCK TX
79453-4136
US

V. Phone/Fax

Practice location:
  • Phone: 806-828-1600
  • Fax: 806-828-1610
Mailing address:
  • Phone: 806-771-1386
  • Fax: 806-771-1388

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: MR. AL BENDECK
Title or Position: PRESIDENT
Credential: PA-C
Phone: 806-828-1600