Provider Demographics
NPI:1003195165
Name:FAMILY MEDICINE RURAL HEALTH CLINIC
Entity Type:Organization
Organization Name:FAMILY MEDICINE RURAL HEALTH CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:L
Authorized Official - Last Name:INGRIM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:903-962-7551
Mailing Address - Street 1:801 N WALDRIP ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:GRAND SALINE
Mailing Address - State:TX
Mailing Address - Zip Code:75140-1024
Mailing Address - Country:US
Mailing Address - Phone:903-962-7551
Mailing Address - Fax:903-962-7122
Practice Address - Street 1:801 N WALDRIP ST
Practice Address - Street 2:SUITE B
Practice Address - City:GRAND SALINE
Practice Address - State:TX
Practice Address - Zip Code:75140-1024
Practice Address - Country:US
Practice Address - Phone:903-962-7551
Practice Address - Fax:903-962-7122
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-08
Last Update Date:2011-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG7239261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health