=====================================================
General NPI Number Information
=====================================================
NPI Number | 1174757223
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PLAINVIEW FOUNDATION FOR RURAL HEALTH ADVANCEMENT
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/05/2009
-----------------------------------------------------
Last Update Date | 05/05/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 202 E. MAIN STREET
-----------------------------------------------------
City | EARTH
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 79031
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 806-257-3329
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 727
-----------------------------------------------------
City | HART
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 79043-0727
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 806-938-2299
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | EXECUTIVE DIRECTOR
-----------------------------------------------------
Name | RETTA J KNOX
-----------------------------------------------------
Credential | RN
-----------------------------------------------------
Telephone | 806-938-2299
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------