Provider Demographics
NPI:1528407061
Name:ML PALMER, PLLC; DBA: BOGATA HEALTH CLINIC
Entity Type:Organization
Organization Name:ML PALMER, PLLC; DBA: BOGATA HEALTH CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:L
Authorized Official - Last Name:PALMER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:903-573-5130
Mailing Address - Street 1:250 MOUNT PLEASANT RD
Mailing Address - Street 2:P O BOX 367
Mailing Address - City:BOGATA
Mailing Address - State:TX
Mailing Address - Zip Code:75417-2769
Mailing Address - Country:US
Mailing Address - Phone:903-632-0111
Mailing Address - Fax:903-632-0292
Practice Address - Street 1:250 MOUNT PLEASANT RD
Practice Address - Street 2:
Practice Address - City:BOGATA
Practice Address - State:TX
Practice Address - Zip Code:75417-2769
Practice Address - Country:US
Practice Address - Phone:903-632-0111
Practice Address - Fax:903-632-0292
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-18
Last Update Date:2013-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX606498363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's HealthGroup - Single Specialty