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NPI Code Detail

MEDICARE: MINUTECLINIC DIAGNOSTIC OF TEXAS PLLC

MEDICARE: MINUTECLINIC DIAGNOSTIC OF TEXAS PLLC
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
1363A00000XPhysician Assistant
21041C0700XClinical Social Worker
3363LF0000XFamily Nurse Practitioner

General Provider Information

NPI Number : 1609076330
Entity Type Code : Organization
Provider Name (Legal Business Name) : MINUTECLINIC DIAGNOSTIC OF TEXAS PLLC
Provider Business Mailing Address
First Line : PO BOX 772 MINUTECLINIC CREDENTIALING
Second Line :
City : WOONSOCKET
State : RI
Zip : 02895-0784
Country : US
Telephone Number : 866-389-2727
Fax Number : 401-406-3539
Provider Business Practice Location Address
First Line : 1855 GATTIS SCHOOL RD
Second Line :
City : ROUND ROCK
State : TX
Zip : 78664-7428
Country : US
Telephone Number : 866-389-2727
Fax Number :
Authorized Official
Title or Position : ADMINISTRATOR
Name : DEBORAH PINCINCE
Credential :
Telephone Number : 401-770-3813
Provider Enumeration Date : 07/20/2007
Last Update Date : 07/02/2024

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