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General NPI Number Information
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NPI Number | 1083683098
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Entity Type | Organization
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Legal Business Name | ORANGE FAMILY CLINIC
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Dates
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Enumeration Date | 03/14/2006
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Last Update Date | 05/20/2024
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Provider Practice Location Address
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Address Line | 3306 RIDGEMONT DR
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City | ORANGE
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State | TX
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Zip | 77630-4236
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Country | US
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Telephone | 409-882-0995
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Fax | 409-883-4440
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Provider Business Mailing Address
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Address Line | PO BOX 669386
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City | DALLAS
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State | TX
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Zip | 75266-9386
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Country | US
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Telephone | 877-896-6474
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Fax | 409-883-4440
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Authorized Official
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Title or Position | OWNER
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Name | NICK POMONIS
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Credential | DO
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Telephone | 409-738-2882
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | H0730
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License Number State | TX
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