Provider Demographics
NPI:1609580034
Name:STATIONAL CARE
Entity Type:Organization
Organization Name:STATIONAL CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:GINA
Authorized Official - Middle Name:
Authorized Official - Last Name:CALEAP
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:682-200-7472
Mailing Address - Street 1:3610 W PIONEER PKWY
Mailing Address - Street 2:
Mailing Address - City:PANTEGO
Mailing Address - State:TX
Mailing Address - Zip Code:76013-4536
Mailing Address - Country:US
Mailing Address - Phone:682-288-8336
Mailing Address - Fax:
Practice Address - Street 1:3610 W PIONEER PKWY STE 101
Practice Address - Street 2:
Practice Address - City:PANTEGO
Practice Address - State:TX
Practice Address - Zip Code:76013-4502
Practice Address - Country:US
Practice Address - Phone:682-288-8336
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-10
Last Update Date:2023-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty