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General NPI Number Information
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NPI Number | 1447711007
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Entity Type | Organization
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Legal Business Name | DMCTX2, PLLC
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Dates
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Enumeration Date | 03/27/2019
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Last Update Date | 09/14/2021
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Provider Practice Location Address
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Address Line | 410 GASLIGHT BLVD
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City | LUFKIN
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State | TX
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Zip | 75904-3123
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Country | US
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Telephone | 936-635-1127
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Fax |
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Provider Business Mailing Address
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Address Line | 410 GASLIGHT BLVD
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City | LUFKIN
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State | TX
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Zip | 75904-3123
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Country | US
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Telephone | 936-630-8813
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | DELLA VICTORIA BUMSTEAD
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Credential |
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Telephone | 409-429-8457
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QU0200X
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Taxonomy Name | Urgent Care Clinic/Center
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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