Healthcare Provider Details

I. General information

NPI: 1780717058
Provider Name (Legal Business Name): SCOTT AND WHITE CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/14/2007
Last Update Date: 06/11/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2401 S 31ST ST
TEMPLE TX
76508-0001
US

IV. Provider business mailing address

2401 S 31ST ST
TEMPLE TX
76508-0001
US

V. Phone/Fax

Practice location:
  • Phone: 254-724-2111
  • Fax:
Mailing address:
  • Phone: 254-724-2111
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: ALICE CANTU
Title or Position: ASSOC VICE PRES, RCO
Credential:
Phone: 254-215-9719