Provider Demographics
NPI:1275906802
Name:CARES CLINIC
Entity Type:Organization
Organization Name:CARES CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:RUSSELL
Authorized Official - Middle Name:
Authorized Official - Last Name:LANG
Authorized Official - Suffix:
Authorized Official - Credentials:BCBAD
Authorized Official - Phone:512-245-7892
Mailing Address - Street 1:601 UNIVERSITY DR
Mailing Address - Street 2:TEXAS STATE UNIVERSITY- CARES CLINIC
Mailing Address - City:SAN MARCOS
Mailing Address - State:TX
Mailing Address - Zip Code:78666-4684
Mailing Address - Country:US
Mailing Address - Phone:512-245-7892
Mailing Address - Fax:512-245-5013
Practice Address - Street 1:601 UNIVERSITY DR
Practice Address - Street 2:TEXAS STATE UNIVERSITY- CARES CLINIC
Practice Address - City:SAN MARCOS
Practice Address - State:TX
Practice Address - Zip Code:78666-4684
Practice Address - Country:US
Practice Address - Phone:512-245-7892
Practice Address - Fax:512-245-5013
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-04
Last Update Date:2015-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXOP142495305S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service