Healthcare Provider Details

I. General information

NPI: 1093868556
Provider Name (Legal Business Name): SPUR MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/19/2007
Last Update Date: 01/30/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

907 E HILL ST
SPUR TX
79370-2532
US

IV. Provider business mailing address

907 E. HILL ST
SPUR TX
79370-2532
US

V. Phone/Fax

Practice location:
  • Phone: 806-271-3306
  • Fax: 806-271-4256
Mailing address:
  • Phone: 806-271-3306
  • Fax: 806-271-4256

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberF3709
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number StateTX

VIII. Authorized Official

Name: MRS. GLENDA WHITE
Title or Position: ADMINISTRATOR
Credential:
Phone: 806-271-3306