Provider Demographics
NPI:1619968054
Name:COUNTY OF YOAKUM
Entity Type:Organization
Organization Name:COUNTY OF YOAKUM
Other - Org Name:PLAINS CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:COLLIN
Authorized Official - Middle Name:
Authorized Official - Last Name:MCLARTY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:806-592-2121
Mailing Address - Street 1:PO BOX 936
Mailing Address - Street 2:
Mailing Address - City:PLAINS
Mailing Address - State:TX
Mailing Address - Zip Code:79355-0936
Mailing Address - Country:US
Mailing Address - Phone:806-456-6365
Mailing Address - Fax:806-456-2057
Practice Address - Street 1:602 ST HWY 214
Practice Address - Street 2:
Practice Address - City:PLAINS
Practice Address - State:TX
Practice Address - Zip Code:79355-0936
Practice Address - Country:US
Practice Address - Phone:806-456-6365
Practice Address - Fax:806-456-2057
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COUNTY OF YOAKUM
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-11-03
Last Update Date:2022-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX458810261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX063623501Medicaid
TX0075DJOtherBLUE CROSS/BLUE SHIELD
TX458810Medicare Oscar/Certification