Provider Demographics
NPI: | 1265022404 |
---|---|
Name: | A1 HEALTH CLINIC LLC |
Entity Type: | Organization |
Organization Name: | A1 HEALTH CLINIC LLC |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | OWNER |
Authorized Official - Prefix: | |
Authorized Official - First Name: | TIFFANY |
Authorized Official - Middle Name: | M |
Authorized Official - Last Name: | LARNETTE |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | FNP-C |
Authorized Official - Phone: | 409-333-1257 |
Mailing Address - Street 1: | 2855 EASTEX FWY STE I |
Mailing Address - Street 2: | |
Mailing Address - City: | BEAUMONT |
Mailing Address - State: | TX |
Mailing Address - Zip Code: | 77706-3065 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 409-333-1242 |
Mailing Address - Fax: | 409-333-1257 |
Practice Address - Street 1: | 2855 EASTEX FWY STE I |
Practice Address - Street 2: | |
Practice Address - City: | BEAUMONT |
Practice Address - State: | TX |
Practice Address - Zip Code: | 77706-3065 |
Practice Address - Country: | US |
Practice Address - Phone: | 409-333-1242 |
Practice Address - Fax: | 409-333-1257 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2021-01-21 |
Last Update Date: | 2023-07-25 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 261QP2300X | Ambulatory Health Care Facilities | Clinic/Center | Primary Care |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
TX | 1669829560 | Other | NPI |