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General NPI Number Information
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NPI Number | 1659584571
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Entity Type | Organization
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Legal Business Name | STRIPLING CLINIC LLC
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Dates
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Enumeration Date | 05/07/2007
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Last Update Date | 03/25/2009
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Provider Practice Location Address
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Address Line | 555 S JACKSON ST
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City | JACKSONVILLE
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State | TX
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Zip | 75766-2414
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Country | US
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Telephone | 903-586-2788
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Fax |
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Provider Business Mailing Address
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Address Line | 555 S JACKSON ST
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City | JACKSONVILLE
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State | TX
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Zip | 75766-2414
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Country | US
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Telephone | 903-586-2788
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | MRS. LAURA C HAYNES
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Credential |
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Telephone | 903-586-2278
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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 | 193200000X
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License Number State | TX
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