Provider Demographics
NPI:1275958332
Name:VASSAR-SHERMAN LLC
Entity Type:Organization
Organization Name:VASSAR-SHERMAN LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:VASSAR
Authorized Official - Suffix:
Authorized Official - Credentials:RD
Authorized Official - Phone:903-472-4975
Mailing Address - Street 1:110 S BOLIVAR ST STE 102
Mailing Address - Street 2:
Mailing Address - City:MARSHALL
Mailing Address - State:TX
Mailing Address - Zip Code:75670-4184
Mailing Address - Country:US
Mailing Address - Phone:903-472-4975
Mailing Address - Fax:903-472-4977
Practice Address - Street 1:110 S BOLIVAR ST STE 102
Practice Address - Street 2:
Practice Address - City:MARSHALL
Practice Address - State:TX
Practice Address - Zip Code:75670-4184
Practice Address - Country:US
Practice Address - Phone:903-472-4975
Practice Address - Fax:903-472-4977
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-26
Last Update Date:2014-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT03384133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty