Provider Demographics
NPI:1194849281
Name:SCOTT & WHITE CLINIC
Entity Type:Organization
Organization Name:SCOTT & WHITE CLINIC
Other - Org Name:SCOTT & WHITE CLINIC EPSDT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHAIRMAN OF CLINIC BOARD
Authorized Official - Prefix:
Authorized Official - First Name:JULIUS
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:DIECKERT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:254-724-2111
Mailing Address - Street 1:2401 S 31ST ST
Mailing Address - Street 2:
Mailing Address - City:TEMPLE
Mailing Address - State:TX
Mailing Address - Zip Code:76508-0001
Mailing Address - Country:US
Mailing Address - Phone:254-724-2111
Mailing Address - Fax:
Practice Address - Street 1:2401 S 31ST ST
Practice Address - Street 2:
Practice Address - City:TEMPLE
Practice Address - State:TX
Practice Address - Zip Code:76508-0001
Practice Address - Country:US
Practice Address - Phone:254-724-2111
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty