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General NPI Number Information
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NPI Number | 1265889703
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Entity Type | Organization
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Legal Business Name | MENAGER FAMILY CLINIC LLC
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Dates
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Enumeration Date | 05/14/2016
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Last Update Date | 09/02/2016
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Provider Practice Location Address
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Address Line | 1406 E HOUSTON ST SUITE B
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City | BEEVILLE
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State | TX
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Zip | 78102-5346
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Country | US
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Telephone | 361-542-1426
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Fax | 361-881-4291
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Provider Business Mailing Address
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Address Line | 404 E JONES ST
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City | BEEVILLE
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State | TX
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Zip | 78102-3532
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Country | US
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Telephone | 361-542-1426
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Fax |
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Authorized Official
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Title or Position | SOLE MBR
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Name | KATHERINE FAYE MENAGER
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Credential | APRN
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Telephone | 361-542-1426
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | AP114056
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License Number State | TX
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