Provider Demographics
NPI:1407186950
Name:TCH FAMILY PRACTICE CLINIC
Entity Type:Organization
Organization Name:TCH FAMILY PRACTICE CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:BETTY
Authorized Official - Middle Name:
Authorized Official - Last Name:HOLTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:409-283-2822
Mailing Address - Street 1:104 N BEECH ST
Mailing Address - Street 2:
Mailing Address - City:WOODVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75979-4718
Mailing Address - Country:US
Mailing Address - Phone:409-283-2822
Mailing Address - Fax:409-283-7852
Practice Address - Street 1:104 N BEECH ST
Practice Address - Street 2:
Practice Address - City:WOODVILLE
Practice Address - State:TX
Practice Address - Zip Code:75979-4718
Practice Address - Country:US
Practice Address - Phone:409-283-2822
Practice Address - Fax:409-283-7852
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TYLER COUNTY HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-01-06
Last Update Date:2010-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX608112261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health