Provider Demographics
NPI:1164890497
Name:LITTLE RIVER HEALTHCARE CENTRAL TEXAS, LLC
Entity Type:Organization
Organization Name:LITTLE RIVER HEALTHCARE CENTRAL TEXAS, LLC
Other - Org Name:LITTLE RIVER HEALTHCARE - SALADO MEDICAL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:TROY
Authorized Official - Middle Name:
Authorized Official - Last Name:ZINN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-446-4500
Mailing Address - Street 1:PO BOX 1010
Mailing Address - Street 2:
Mailing Address - City:ROCKDALE
Mailing Address - State:TX
Mailing Address - Zip Code:76567-1010
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:213 MILL CREEK DR
Practice Address - Street 2:SUITE 180
Practice Address - City:SALADO
Practice Address - State:TX
Practice Address - Zip Code:76571-5537
Practice Address - Country:US
Practice Address - Phone:254-947-9044
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-03
Last Update Date:2016-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health