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General NPI Number Information
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NPI Number | 1184610412
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Entity Type | Organization
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Legal Business Name | GREATER TEXARKANA PEOPLE'S CLINIC, INC.
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Dates
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Enumeration Date | 09/22/2005
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1102 MAIN ST
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City | TEXARKANA
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State | TX
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Zip | 75501-4313
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Country | US
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Telephone | 903-255-0220
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Fax | 903-255-0222
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Provider Business Mailing Address
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Address Line | 1102 MAIN ST
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City | TEXARKANA
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State | TX
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Zip | 75501-4313
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Country | US
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Telephone | 903-255-0220
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Fax | 903-255-0222
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Authorized Official
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Title or Position | OPERATIONS DIRECTOR
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Name | MS. FREDDIE BARBER
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Credential | RN
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Telephone | 903-255-0220
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | PA01831
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License Number State | TX
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