MEDICARE: LINDALE MEDICAL CLINIC, INC

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
1	207Q00000X	Family Medicine Physician	H0425	TX
2	207Q00000X	Family Medicine Physician	H0424	TX

General Provider Information

NPI Number	:	1568455673
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LINDALE MEDICAL CLINIC, INC

Provider Business Mailing Address
First Line	:	PO BOX 1509
Second Line	:
City	:	LINDALE
State	:	TX
Zip	:	75771-1509
Country	:	US
Telephone Number	:	903-882-3194
Fax Number	:	903-882-7405

Provider Business Practice Location Address
First Line	:	206 W HUBBARD ST
Second Line	:
City	:	LINDALE
State	:	TX
Zip	:	75771-6215
Country	:	US
Telephone Number	:	903-882-3164
Fax Number	:	903-882-7405

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	MRS. SHERI R TUCKER
Credential	:
Telephone Number	:	903-882-3194

Provider Enumeration Date	:	08/24/2005
Last Update Date	:	04/27/2016

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