Provider Demographics
NPI:1205817319
Name:MARSHALL RURAL HEALTH CLINIC
Entity Type:Organization
Organization Name:MARSHALL RURAL HEALTH CLINIC
Other - Org Name:MARSHALL REGIONAL MEDICAL CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:FAMILY NURSE PRACTITIONER
Authorized Official - Prefix:MR
Authorized Official - First Name:DWIGHT
Authorized Official - Middle Name:RAYMOND
Authorized Official - Last Name:CLEMANS
Authorized Official - Suffix:
Authorized Official - Credentials:FNP-C
Authorized Official - Phone:903-927-6140
Mailing Address - Street 1:7914 FM-9 SOUTH
Mailing Address - Street 2:
Mailing Address - City:WASKOM
Mailing Address - State:TX
Mailing Address - Zip Code:75692-7914
Mailing Address - Country:US
Mailing Address - Phone:903-633-2802
Mailing Address - Fax:
Practice Address - Street 1:703 S WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:MARSHALL
Practice Address - State:TX
Practice Address - Zip Code:75670-5337
Practice Address - Country:US
Practice Address - Phone:903-927-6140
Practice Address - Fax:903-927-6117
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX623027261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health