Provider Demographics
NPI:1285039289
Name:GREATER KILLEEN FREE CLINIC
Entity Type:Organization
Organization Name:GREATER KILLEEN FREE CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MARLENE
Authorized Official - Middle Name:
Authorized Official - Last Name:DILILLO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:254-618-4211
Mailing Address - Street 1:718-A N 2ND STR
Mailing Address - Street 2:
Mailing Address - City:KILLEEN
Mailing Address - State:TX
Mailing Address - Zip Code:76541
Mailing Address - Country:US
Mailing Address - Phone:254-618-4211
Mailing Address - Fax:254-618-4208
Practice Address - Street 1:718 N 2ND STR, SUITE A
Practice Address - Street 2:
Practice Address - City:KILLEEN
Practice Address - State:TX
Practice Address - Zip Code:76541
Practice Address - Country:US
Practice Address - Phone:254-618-4211
Practice Address - Fax:254-618-4208
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-03
Last Update Date:2014-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health