Provider Demographics
NPI:1568581775
Name:THE EAGLE FORD CLINICS, PA
Entity Type:Organization
Organization Name:THE EAGLE FORD CLINICS, PA
Other - Org Name:HOOD MEDICAL CLINICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MD/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SURESH
Authorized Official - Middle Name:V
Authorized Official - Last Name:DUTTA
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:830-965-1684
Mailing Address - Street 1:111 E. MILLER ST.
Mailing Address - Street 2:
Mailing Address - City:DILLEY
Mailing Address - State:TX
Mailing Address - Zip Code:78017
Mailing Address - Country:US
Mailing Address - Phone:830-965-1684
Mailing Address - Fax:830-965-1278
Practice Address - Street 1:111 E. MILLER ST.
Practice Address - Street 2:
Practice Address - City:DILLEY
Practice Address - State:TX
Practice Address - Zip Code:78017
Practice Address - Country:US
Practice Address - Phone:830-965-1684
Practice Address - Fax:830-965-1278
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-28
Last Update Date:2016-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX187810001Medicaid
TX0057PDOtherBCBS GRP NUMBER
TX00X375OtherMEDICARE GROUP
TX0057PDOtherBCBS GRP NUMBER