Provider Demographics
NPI:1093868556
Name:SPUR MEDICAL CORPORATION
Entity Type:Organization
Organization Name:SPUR MEDICAL CORPORATION
Other - Org Name:SPUR CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:GLENDA
Authorized Official - Middle Name:
Authorized Official - Last Name:WHITE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:806-271-3306
Mailing Address - Street 1:907 E. HILL ST
Mailing Address - Street 2:
Mailing Address - City:SPUR
Mailing Address - State:TX
Mailing Address - Zip Code:79370-2532
Mailing Address - Country:US
Mailing Address - Phone:806-271-3306
Mailing Address - Fax:806-271-4256
Practice Address - Street 1:907 E HILL ST
Practice Address - Street 2:
Practice Address - City:SPUR
Practice Address - State:TX
Practice Address - Zip Code:79370-2532
Practice Address - Country:US
Practice Address - Phone:806-271-3306
Practice Address - Fax:806-271-4256
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-19
Last Update Date:2009-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF3709207Q00000X
TX261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX063674801Medicaid
TX079808401Medicaid
TX100106106OtherFIRSTCARE PROVIDER NUMBER
TX1275617177OtherSTEVE B. ALLEY, M.D. NPI
TX1285787762OtherJENNIFER WARREN, NPI#
TX137930707Medicaid
TX0636748-02Medicaid
TX673807Medicare Oscar/Certification
TXC12755Medicare UPIN
TX063674801Medicaid
TX137930707Medicaid
TX1285787762OtherJENNIFER WARREN, NPI#
TX1275617177OtherSTEVE B. ALLEY, M.D. NPI