Provider Demographics
NPI:1609443829
Name:TEXARKANA SENIOR CARE CLINIC PLLC
Entity Type:Organization
Organization Name:TEXARKANA SENIOR CARE CLINIC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:K
Authorized Official - Last Name:HEFLIN
Authorized Official - Suffix:
Authorized Official - Credentials:CERTIFIED NURSE PRAC
Authorized Official - Phone:903-716-8808
Mailing Address - Street 1:5902 SUMMERFIELD DR STE A
Mailing Address - Street 2:
Mailing Address - City:TEXARKANA
Mailing Address - State:TX
Mailing Address - Zip Code:75503-4307
Mailing Address - Country:US
Mailing Address - Phone:903-716-8808
Mailing Address - Fax:903-716-8799
Practice Address - Street 1:5902 SUMMERFIELD DR STE A
Practice Address - Street 2:
Practice Address - City:TEXARKANA
Practice Address - State:TX
Practice Address - Zip Code:75503-4307
Practice Address - Country:US
Practice Address - Phone:903-716-8808
Practice Address - Fax:903-716-8799
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-07
Last Update Date:2021-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric MedicineGroup - Multi-Specialty