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General NPI Number Information
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NPI Number | 1194804278
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Entity Type | Organization
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Legal Business Name | SHACKELFORD COUNTY COMMUNITY RESOURCE CENTER
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Dates
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Enumeration Date | 11/02/2006
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Last Update Date | 06/11/2021
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Provider Practice Location Address
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Address Line | 725 PATE ST
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City | ALBANY
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State | TX
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Zip | 76430-3225
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Country | US
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Telephone | 325-762-2447
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Fax | 325-762-2186
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Provider Business Mailing Address
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Address Line | PO BOX 2435
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City | ALBANY
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State | TX
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Zip | 76430-8020
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Country | US
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Telephone | 325-762-2447
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Fax | 325-762-2186
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Authorized Official
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Title or Position | BILLING MANAGER/CREDENTIALER
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Name | TINA LOUISE BETCHER
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Credential |
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Telephone | 325-893-4010
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QF0400X
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Taxonomy Name | Federally Qualified Health Center (FQHC)
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License Number | 30117281979
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License Number State | TX
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