=====================================================
General NPI Number Information
=====================================================
NPI Number | 1508938424
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HICO CLINIC, P.A.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/15/2006
-----------------------------------------------------
Last Update Date | 01/28/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 104 WALNUT
-----------------------------------------------------
City | HICO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76457
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 254-796-4224
-----------------------------------------------------
Fax | 254-796-4064
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX H
-----------------------------------------------------
City | HICO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76457-0230
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 254-796-4224
-----------------------------------------------------
Fax | 254-796-4064
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMINISTRATOR
-----------------------------------------------------
Name | DR. BILLY CHARLES DAYTON
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 254-796-4224
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QR1300X
-----------------------------------------------------
Taxonomy Name | Rural Health Clinic/Center
-----------------------------------------------------
License Number | 673869
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------