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General NPI Number Information
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NPI Number | 1033258710
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Entity Type | Organization
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Legal Business Name | RAPHAEL COMMUNITY FREE CLINIC
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Dates
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Enumeration Date | 02/06/2007
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Last Update Date | 03/28/2012
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Provider Practice Location Address
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Address Line | 1807 WATER ST
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City | KERRVILLE
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State | TX
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Zip | 78028-6023
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Country | US
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Telephone | 830-895-4201
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Fax | 830-895-3985
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Provider Business Mailing Address
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Address Line | 1807 WATER ST
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City | KERRVILLE
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State | TX
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Zip | 78028-6023
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CLINIC DIRECTOR
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Name | MARGARET MARY NOVAK
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Credential | FNP
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Telephone | 830-895-4201
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251V00000X
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Taxonomy Name | Voluntary or Charitable Agency
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License Number | 527725
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License Number State | TX
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