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General NPI Number Information
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NPI Number | 1093936775
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Entity Type | Organization
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Legal Business Name | ALICE OBGYN SPECIALTY CLINIC, PA
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Dates
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Enumeration Date | 05/01/2007
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Last Update Date | 04/16/2008
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Provider Practice Location Address
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Address Line | 2510 E MAIN ST SUITE 106
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City | ALICE
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State | TX
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Zip | 78332-4187
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Country | US
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Telephone | 361-664-6671
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Fax | 361-664-6686
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Provider Business Mailing Address
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Address Line | PO BOX 970
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City | ALICE
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State | TX
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Zip | 78333-0970
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Country | US
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Telephone | 361-664-6671
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Fax | 361-664-6686
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | HEATHER C HASETTE IV
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Credential |
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Telephone | 361-664-6671
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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 | L6230
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License Number State | TX
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