Provider Demographics
NPI:1083019905
Name:PEOPLE'S COMMUNITY CLINIC, INC.
Entity Type:Organization
Organization Name:PEOPLE'S COMMUNITY CLINIC, INC.
Other - Org Name:PEOPLE'S COMMUNITY CLINIC OFF-SITE CLINIC AT MANOR
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:REGINA
Authorized Official - Middle Name:
Authorized Official - Last Name:ROGOFF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-684-1721
Mailing Address - Street 1:1101 CAMINO LA COSTA
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78752-3930
Mailing Address - Country:US
Mailing Address - Phone:512-478-4939
Mailing Address - Fax:512-320-0702
Practice Address - Street 1:10335 US HIGHWAY 290 E
Practice Address - Street 2:
Practice Address - City:MANOR
Practice Address - State:TX
Practice Address - Zip Code:78653-4686
Practice Address - Country:US
Practice Address - Phone:512-278-4462
Practice Address - Fax:512-278-4017
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-04
Last Update Date:2018-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)