Provider Demographics
NPI:1508003666
Name:AMBIANCE FAMILY MEDICAL CLINIC,LLC
Entity Type:Organization
Organization Name:AMBIANCE FAMILY MEDICAL CLINIC,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:SERAPIO
Authorized Official - Middle Name:
Authorized Official - Last Name:SERNA
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:361-661-0400
Mailing Address - Street 1:2041 E MAIN ST
Mailing Address - Street 2:SUITE 500
Mailing Address - City:ALICE
Mailing Address - State:TX
Mailing Address - Zip Code:78332-4158
Mailing Address - Country:US
Mailing Address - Phone:361-661-0400
Mailing Address - Fax:361-661-0522
Practice Address - Street 1:2041 E MAIN ST
Practice Address - Street 2:SUITE 500
Practice Address - City:ALICE
Practice Address - State:TX
Practice Address - Zip Code:78332-4158
Practice Address - Country:US
Practice Address - Phone:361-661-0400
Practice Address - Fax:361-661-0522
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-12
Last Update Date:2009-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health