Provider Demographics
NPI:1689738338
Name:LUFKIN ADULT MEDICINE CLINIC
Entity Type:Organization
Organization Name:LUFKIN ADULT MEDICINE CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:S
Authorized Official - Last Name:SANTIAGO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:936-632-9277
Mailing Address - Street 1:202 S BYNUM ST
Mailing Address - Street 2:
Mailing Address - City:LUFKIN
Mailing Address - State:TX
Mailing Address - Zip Code:75904-3913
Mailing Address - Country:US
Mailing Address - Phone:936-632-9277
Mailing Address - Fax:936-632-9285
Practice Address - Street 1:202 S BYNUM ST
Practice Address - Street 2:
Practice Address - City:LUFKIN
Practice Address - State:TX
Practice Address - Zip Code:75904-3913
Practice Address - Country:US
Practice Address - Phone:936-632-9277
Practice Address - Fax:936-632-9285
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-20
Last Update Date:2011-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX142942501Medicaid
TX142942501Medicaid