Provider Demographics
NPI:1528380854
Name:MARFA COUNTRY CLINIC, P.A.
Entity Type:Organization
Organization Name:MARFA COUNTRY CLINIC, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:VALERIE
Authorized Official - Middle Name:
Authorized Official - Last Name:CULBERTSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:432-729-3000
Mailing Address - Street 1:PO BOX 368
Mailing Address - Street 2:
Mailing Address - City:MARFA
Mailing Address - State:TX
Mailing Address - Zip Code:79843-0368
Mailing Address - Country:US
Mailing Address - Phone:432-729-3000
Mailing Address - Fax:
Practice Address - Street 1:105 EAST OAK STREET
Practice Address - Street 2:
Practice Address - City:MARFA
Practice Address - State:TX
Practice Address - Zip Code:79843
Practice Address - Country:US
Practice Address - Phone:432-729-3000
Practice Address - Fax:432-729-3001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-01
Last Update Date:2019-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA02637261QP2300X
TXG0083261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care