Provider Demographics
NPI:1376096263
Name:MEXIA PRINCIPAL HEALTHCARE LIMITED PARTNERSHIP
Entity Type:Organization
Organization Name:MEXIA PRINCIPAL HEALTHCARE LIMITED PARTNERSHIP
Other - Org Name:PARKVEIW RURAL HEALTH CLINIC OF BUFFALO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MARKET DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MONA
Authorized Official - Middle Name:JILL
Authorized Official - Last Name:FERGUSON
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:254-562-9321
Mailing Address - Street 1:PO BOX 669
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:TX
Mailing Address - Zip Code:75831-0669
Mailing Address - Country:US
Mailing Address - Phone:903-322-1215
Mailing Address - Fax:903-322-1217
Practice Address - Street 1:1686 W US HIGHWAY 79
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:TX
Practice Address - Zip Code:75831-3490
Practice Address - Country:US
Practice Address - Phone:903-322-1215
Practice Address - Fax:903-322-1217
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MEXIA PRINCIPAL HEALTHCARE LIMITED PARTNERSHIP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-07-27
Last Update Date:2016-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health