Provider Demographics
NPI:1225644537
Name:SUDAN MEDICAL CLINIC, LLC
Entity Type:Organization
Organization Name:SUDAN MEDICAL CLINIC, LLC
Other - Org Name:SUDAN MEDICAL CLINIC - MULESHOE LOCATION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:M
Authorized Official - Last Name:ALLEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:806-227-2292
Mailing Address - Street 1:PO BOX 119
Mailing Address - Street 2:
Mailing Address - City:SUDAN
Mailing Address - State:TX
Mailing Address - Zip Code:79371-0119
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:208 W 2ND ST
Practice Address - Street 2:
Practice Address - City:MULESHOE
Practice Address - State:TX
Practice Address - Zip Code:79347-3631
Practice Address - Country:US
Practice Address - Phone:806-272-7736
Practice Address - Fax:806-272-7737
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-22
Last Update Date:2023-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty