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General NPI Number Information
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NPI Number | 1285039289
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Entity Type | Organization
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Legal Business Name | GREATER KILLEEN FREE CLINIC
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Dates
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Enumeration Date | 11/03/2014
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Last Update Date | 11/03/2014
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Provider Practice Location Address
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Address Line | 718 N 2ND STR, SUITE A
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City | KILLEEN
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State | TX
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Zip | 76541
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Country | US
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Telephone | 254-618-4211
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Fax | 254-618-4208
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Provider Business Mailing Address
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Address Line | 718-A N 2ND STR
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City | KILLEEN
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State | TX
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Zip | 76541
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Country | US
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Telephone | 254-618-4211
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Fax | 254-618-4208
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MARLENE DILILLO
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Credential |
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Telephone | 254-618-4211
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QC1500X
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Taxonomy Name | Community Health Clinic/Center
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License Number |
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License Number State |
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