Healthcare Provider Details

I. General information

NPI: 1780746339
Provider Name (Legal Business Name): MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/13/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

203 A EAST JEFFERSON
WHITNEY TX
76692
US

IV. Provider business mailing address

PO BOX 2570
WHITNEY TX
76692-5570
US

V. Phone/Fax

Practice location:
  • Phone: 254-694-9400
  • Fax: 254-694-9175
Mailing address:
  • Phone: 254-694-9400
  • Fax: 254-694-9175

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code305S00000X
TaxonomyPoint of Service
License NumberF7521
License Number StateTX

VIII. Authorized Official

Name: TERESA V MANAX
Title or Position: CO-OWNER
Credential: M.D.
Phone: 254-694-9400