Provider Demographics
NPI:1093774317
Name:UNITED CLINICS OF NORTH TEXAS, PLLC
Entity Type:Organization
Organization Name:UNITED CLINICS OF NORTH TEXAS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INSURANCE CLERK
Authorized Official - Prefix:
Authorized Official - First Name:DENISE
Authorized Official - Middle Name:
Authorized Official - Last Name:HANCOCK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:940-872-1121
Mailing Address - Street 1:1010 N MILL STREET
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:TX
Mailing Address - Zip Code:76230
Mailing Address - Country:US
Mailing Address - Phone:940-872-1121
Mailing Address - Fax:940-872-3007
Practice Address - Street 1:1010 N MILL ST
Practice Address - Street 2:
Practice Address - City:BOWIE
Practice Address - State:TX
Practice Address - Zip Code:76230-3120
Practice Address - Country:US
Practice Address - Phone:940-872-1121
Practice Address - Fax:940-872-3007
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-23
Last Update Date:2011-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX121055101Medicaid
TX121055101Medicaid
TX453929Medicare Oscar/Certification