Provider Demographics
NPI:1164863312
Name:TEXOMA COMMUNITY CENTER
Entity Type:Organization
Organization Name:TEXOMA COMMUNITY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING SPECIALIST
Authorized Official - Prefix:MS
Authorized Official - First Name:NANCI
Authorized Official - Middle Name:M
Authorized Official - Last Name:BRUNO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:903-957-4861
Mailing Address - Street 1:PO BOX 1087
Mailing Address - Street 2:
Mailing Address - City:SHERMAN
Mailing Address - State:TX
Mailing Address - Zip Code:75091-1087
Mailing Address - Country:US
Mailing Address - Phone:903-957-4861
Mailing Address - Fax:903-957-3416
Practice Address - Street 1:315 W MCLAIN DR
Practice Address - Street 2:
Practice Address - City:SHERMAN
Practice Address - State:TX
Practice Address - Zip Code:75092-2605
Practice Address - Country:US
Practice Address - Phone:903-957-4701
Practice Address - Fax:903-957-3416
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-16
Last Update Date:2016-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX3703-3704261QM0801X, 261QR0405X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00P876Medicare PIN