Provider Demographics
NPI:1447403399
Name:FIRM FOUNDATIONS HEALTHCARE CLINIC PC
Entity Type:Organization
Organization Name:FIRM FOUNDATIONS HEALTHCARE CLINIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:JANEL
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:936-334-8800
Mailing Address - Street 1:2708 JEFFERSON DR STE A
Mailing Address - Street 2:
Mailing Address - City:LIBERTY
Mailing Address - State:TX
Mailing Address - Zip Code:77575-1036
Mailing Address - Country:US
Mailing Address - Phone:936-334-8800
Mailing Address - Fax:936-334-8801
Practice Address - Street 1:2708 JEFFERSON DR STE A
Practice Address - Street 2:
Practice Address - City:LIBERTY
Practice Address - State:TX
Practice Address - Zip Code:77575-1036
Practice Address - Country:US
Practice Address - Phone:936-334-8800
Practice Address - Fax:936-334-8801
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-23
Last Update Date:2023-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0A0340OtherPTAN