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General NPI Number Information
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NPI Number | 1134893977
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Entity Type | Organization
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Legal Business Name | TEXAS ROSE FAMILY CLINIC PLLC
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Dates
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Enumeration Date | 08/05/2021
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Last Update Date | 08/05/2021
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Provider Practice Location Address
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Address Line | 1900 PEASE ST STE 208
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City | VERNON
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State | TX
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Zip | 76384-4626
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Country | US
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Telephone | 940-553-7036
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Fax | 940-553-7056
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Provider Business Mailing Address
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Address Line | 1900 PEASE ST STE 208
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City | VERNON
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State | TX
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Zip | 76384-4626
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Country | US
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Telephone | 940-553-7036
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Fax | 940-553-7056
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | KIMBERLY BABB
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Credential |
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Telephone | 325-234-7580
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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