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General NPI Number Information
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NPI Number | 1508003666
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Entity Type | Organization
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Legal Business Name | AMBIANCE FAMILY MEDICAL CLINIC,LLC
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Dates
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Enumeration Date | 01/12/2009
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Last Update Date | 07/30/2009
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Provider Practice Location Address
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Address Line | 2041 E MAIN ST SUITE 500
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City | ALICE
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State | TX
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Zip | 78332-4158
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Country | US
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Telephone | 361-661-0400
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Fax | 361-661-0522
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Provider Business Mailing Address
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Address Line | 2041 E MAIN ST SUITE 500
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City | ALICE
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State | TX
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Zip | 78332-4158
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Country | US
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Telephone | 361-661-0400
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Fax | 361-661-0522
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Authorized Official
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Title or Position | CEO
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Name | MR. SERAPIO SERNA JR.
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Credential |
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Telephone | 361-661-0400
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR1300X
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Taxonomy Name | Rural Health Clinic/Center
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License Number |
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License Number State |
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