Provider Demographics
NPI:1508938424
Name:HICO CLINIC, P.A.
Entity Type:Organization
Organization Name:HICO CLINIC, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:BILLY
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:DAYTON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:254-796-4224
Mailing Address - Street 1:PO BOX H
Mailing Address - Street 2:
Mailing Address - City:HICO
Mailing Address - State:TX
Mailing Address - Zip Code:76457-0230
Mailing Address - Country:US
Mailing Address - Phone:254-796-4224
Mailing Address - Fax:254-796-4064
Practice Address - Street 1:104 WALNUT
Practice Address - Street 2:
Practice Address - City:HICO
Practice Address - State:TX
Practice Address - Zip Code:76457
Practice Address - Country:US
Practice Address - Phone:254-796-4224
Practice Address - Fax:254-796-4064
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-15
Last Update Date:2008-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX673869261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX122918OtherCHIPS
TX807884OtherBLUE CROSS BLUE SHIELD
TX5561178OtherAETNA
TX807884OtherBLUE CROSS BLUE SHIELD
TX122918OtherCHIPS