Provider Demographics
NPI:1346909231
Name:WHITE COAT MEDICAL, PLLC
Entity Type:Organization
Organization Name:WHITE COAT MEDICAL, PLLC
Other - Org Name:JARRELL MEDICAL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:RAMIRO
Authorized Official - Middle Name:ABRAHAM
Authorized Official - Last Name:PENA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:512-588-1501
Mailing Address - Street 1:180 TOWN CENTER BLVD STE 400
Mailing Address - Street 2:
Mailing Address - City:JARRELL
Mailing Address - State:TX
Mailing Address - Zip Code:76537-4007
Mailing Address - Country:US
Mailing Address - Phone:512-850-9143
Mailing Address - Fax:512-287-5582
Practice Address - Street 1:180 TOWN CENTER BLVD STE 400
Practice Address - Street 2:
Practice Address - City:JARRELL
Practice Address - State:TX
Practice Address - Zip Code:76537-4007
Practice Address - Country:US
Practice Address - Phone:512-850-9143
Practice Address - Fax:512-287-5582
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-08
Last Update Date:2022-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXD1001OtherFAMILY PRACTICE
TX1033714OtherFAMILY PRACTICE