Provider Demographics
NPI:1033258710
Name:RAPHAEL COMMUNITY FREE CLINIC
Entity Type:Organization
Organization Name:RAPHAEL COMMUNITY FREE CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MARGARET
Authorized Official - Middle Name:MARY
Authorized Official - Last Name:NOVAK
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:830-895-4201
Mailing Address - Street 1:1807 WATER ST
Mailing Address - Street 2:
Mailing Address - City:KERRVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78028-6023
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1807 WATER ST
Practice Address - Street 2:
Practice Address - City:KERRVILLE
Practice Address - State:TX
Practice Address - Zip Code:78028-6023
Practice Address - Country:US
Practice Address - Phone:830-895-4201
Practice Address - Fax:830-895-3985
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-06
Last Update Date:2012-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX527725251V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251V00000XAgenciesVoluntary or Charitable