Provider Demographics
NPI:1326029844
Name:THE EAGLE FORD CLINICS, PA
Entity Type:Organization
Organization Name:THE EAGLE FORD CLINICS, PA
Other - Org Name:HOOD MEDICAL CLINICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SURESH
Authorized Official - Middle Name:V
Authorized Official - Last Name:DUTTA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:830-965-1684
Mailing Address - Street 1:207 TILDEN
Mailing Address - Street 2:
Mailing Address - City:COTULLA
Mailing Address - State:TX
Mailing Address - Zip Code:78014-2161
Mailing Address - Country:US
Mailing Address - Phone:830-879-2358
Mailing Address - Fax:830-879-3107
Practice Address - Street 1:207 TILDEN
Practice Address - Street 2:
Practice Address - City:COTULLA
Practice Address - State:TX
Practice Address - Zip Code:78014-2161
Practice Address - Country:US
Practice Address - Phone:830-879-2358
Practice Address - Fax:830-879-3107
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-10
Last Update Date:2014-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX135106603Medicaid
TX135106606Medicaid
TX135106606Medicaid