Provider Demographics
NPI:1407958705
Name:MARFA HEALTH & WELLNESS, INC.
Entity Type:Organization
Organization Name:MARFA HEALTH & WELLNESS, INC.
Other - Org Name:MARFA COMMUNITY HEALTH CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:MARILYN
Authorized Official - Middle Name:M
Authorized Official - Last Name:SANDERS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:432-729-1800
Mailing Address - Street 1:PO BOX 267
Mailing Address - Street 2:
Mailing Address - City:MARFA
Mailing Address - State:TX
Mailing Address - Zip Code:79843-0267
Mailing Address - Country:US
Mailing Address - Phone:432-729-1800
Mailing Address - Fax:432-729-1806
Practice Address - Street 1:210 S SUMMER ST
Practice Address - Street 2:
Practice Address - City:MARFA
Practice Address - State:TX
Practice Address - Zip Code:79843-0267
Practice Address - Country:US
Practice Address - Phone:432-729-1800
Practice Address - Fax:432-729-1806
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-05
Last Update Date:2007-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0068MXOtherBCBS TX
00701YMedicare PIN