Provider Demographics
NPI:1720204795
Name:CLIFTON H. CATHCART, D.O., P.A.
Entity Type:Organization
Organization Name:CLIFTON H. CATHCART, D.O., P.A.
Other - Org Name:CATHCART MEDICAL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:CLIFTON
Authorized Official - Middle Name:H
Authorized Official - Last Name:CATHCART DO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:936-637-2080
Mailing Address - Street 1:1702 E DENMAN AVE
Mailing Address - Street 2:
Mailing Address - City:LUFKIN
Mailing Address - State:TX
Mailing Address - Zip Code:75901-6110
Mailing Address - Country:US
Mailing Address - Phone:936-639-1224
Mailing Address - Fax:936-637-7917
Practice Address - Street 1:1702 E DENMAN AVE
Practice Address - Street 2:
Practice Address - City:LUFKIN
Practice Address - State:TX
Practice Address - Zip Code:75901-6110
Practice Address - Country:US
Practice Address - Phone:936-637-2080
Practice Address - Fax:936-637-7917
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-18
Last Update Date:2020-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF0412207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00CA20OtherBCBS
TX032423802Medicaid
TX00CA20OtherBCBS
TX032423802Medicaid