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NPI Code Detail

MEDICARE: LAKE WHITNEY PHYSICIANS CLINIC LLC

MEDICARE: LAKE WHITNEY PHYSICIANS CLINIC LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207Q00000XFamily Medicine Physician

General Provider Information

NPI Number : 1053744862
Entity Type Code : Organization
Provider Name (Legal Business Name) : LAKE WHITNEY PHYSICIANS CLINIC LLC
Provider Business Mailing Address
First Line : 202 E JEFFERSON AVE
Second Line :
City : WHITNEY
State : TX
Zip : 76692-2398
Country : US
Telephone Number : 254-694-2221
Fax Number : 254-694-9978
Provider Business Practice Location Address
First Line : 202 E JEFFERSON AVE
Second Line :
City : WHITNEY
State : TX
Zip : 76692-2398
Country : US
Telephone Number : 254-694-2221
Fax Number : 254-694-9978
Authorized Official
Title or Position : CFO, MEMBER, ADMINISTRATOR
Name : LINDA HALL
Credential :
Telephone Number : 254-694-2221
Provider Enumeration Date : 08/15/2013
Last Update Date : 08/15/2013

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Directions to “LAKE WHITNEY PHYSICIANS CLINIC LLC ” Practice Location

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These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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