Provider Demographics
NPI:1073598496
Name:STRIPLING CLINIC
Entity Type:Organization
Organization Name:STRIPLING CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOE
Authorized Official - Middle Name:RANDOLPH
Authorized Official - Last Name:DANEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:903-586-2278
Mailing Address - Street 1:555 S JACKSON ST
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75766-2476
Mailing Address - Country:US
Mailing Address - Phone:903-586-2278
Mailing Address - Fax:903-586-3127
Practice Address - Street 1:555 S JACKSON ST
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:TX
Practice Address - Zip Code:75766-2476
Practice Address - Country:US
Practice Address - Phone:903-586-2278
Practice Address - Fax:903-586-3127
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-08
Last Update Date:2008-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXD9115207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX034812001Medicaid
00M688Medicare ID - Type Unspecified
TX034812001Medicaid