Provider Demographics
NPI:1073651832
Name:NORTH CENTRAL TEXAS COMMUNITY HEALTH CARE CENTER
Entity Type:Organization
Organization Name:NORTH CENTRAL TEXAS COMMUNITY HEALTH CARE CENTER
Other - Org Name:CHC PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ALLEN
Authorized Official - Middle Name:
Authorized Official - Last Name:PATTERSON, CHIEF EXECUTIVE OFFICER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:940-766-6306
Mailing Address - Street 1:200 MLK JR BLVD
Mailing Address - Street 2:
Mailing Address - City:WICHITA FALLS
Mailing Address - State:TX
Mailing Address - Zip Code:76301-1152
Mailing Address - Country:US
Mailing Address - Phone:940-766-6306
Mailing Address - Fax:940-397-2675
Practice Address - Street 1:200 MLK JR BLVD
Practice Address - Street 2:
Practice Address - City:WICHITA FALLS
Practice Address - State:TX
Practice Address - Zip Code:76301-1152
Practice Address - Country:US
Practice Address - Phone:940-766-6306
Practice Address - Fax:940-397-2675
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NORTH CENTRAL TEXAS COMMUNITY HEALTH CARE CENTER INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-02-02
Last Update Date:2020-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX160613336C0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0002XSuppliersPharmacyClinic Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX4592831OtherNCPDP