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General NPI Number Information
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NPI Number | 1992763684
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Entity Type | Organization
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Legal Business Name | DEWEYVILLE RURAL HEALTH CLINIC LLC
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Dates
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Enumeration Date | 05/02/2006
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Last Update Date | 07/21/2008
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Provider Practice Location Address
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Address Line | 2493 STATE HIGHWAY 12 E
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City | ORANGE
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State | TX
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Zip | 77632-8426
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Country | US
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Telephone | 409-746-7000
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Fax | 409-746-7016
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Provider Business Mailing Address
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Address Line | 2493 STATE HIGHWAY 12 E
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City | ORANGE
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State | TX
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Zip | 77632-8426
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Country | US
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Telephone | 409-746-7000
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Fax | 409-746-7016
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Authorized Official
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Title or Position | OWNER
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Name | MR. WILLIAM DAVID DUNN
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Credential | FNP
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Telephone | 409-746-7000
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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 | 10-560939-6
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License Number State | TX
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