Provider Demographics
NPI:1093251761
Name:NACOGDOCHES HEALTH PARTNERS ACCESS CLINIC, PLLC
Entity Type:Organization
Organization Name:NACOGDOCHES HEALTH PARTNERS ACCESS CLINIC, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:WILBURN
Authorized Official - Middle Name:E
Authorized Official - Last Name:FURNISS
Authorized Official - Suffix:III
Authorized Official - Credentials:MD
Authorized Official - Phone:936-559-0700
Mailing Address - Street 1:4800 NE STALLINGS DR STE 109
Mailing Address - Street 2:
Mailing Address - City:NACOGDOCHES
Mailing Address - State:TX
Mailing Address - Zip Code:75965-1250
Mailing Address - Country:US
Mailing Address - Phone:936-559-0700
Mailing Address - Fax:936-559-0500
Practice Address - Street 1:4800 NE STALLINGS DR STE 109
Practice Address - Street 2:
Practice Address - City:NACOGDOCHES
Practice Address - State:TX
Practice Address - Zip Code:75965-1250
Practice Address - Country:US
Practice Address - Phone:936-559-0700
Practice Address - Fax:936-559-0500
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-18
Last Update Date:2017-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN2078207Q00000X
261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty