Provider Demographics
NPI:1396414371
Name:COUNTY OF CLAY
Entity Type:Organization
Organization Name:COUNTY OF CLAY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:
Authorized Official - Last Name:HAEHN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:940-538-5621
Mailing Address - Street 1:310 W SOUTH ST, HENRIETTA TX 76365
Mailing Address - Street 2:
Mailing Address - City:HENRIETTA
Mailing Address - State:TX
Mailing Address - Zip Code:76365-3346
Mailing Address - Country:US
Mailing Address - Phone:940-235-1202
Mailing Address - Fax:940-235-1215
Practice Address - Street 1:412 S ARCHER
Practice Address - Street 2:
Practice Address - City:HENRIETTA
Practice Address - State:TX
Practice Address - Zip Code:76365
Practice Address - Country:US
Practice Address - Phone:940-235-1202
Practice Address - Fax:940-235-1215
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-13
Last Update Date:2021-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty