Provider Demographics
NPI:1740237148
Name:ALVORD MEDICAL CLINIC, PA
Entity Type:Organization
Organization Name:ALVORD MEDICAL CLINIC, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JEFFERSON
Authorized Official - Middle Name:B
Authorized Official - Last Name:ALLING
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:940-627-7829
Mailing Address - Street 1:PO BOX 49
Mailing Address - Street 2:
Mailing Address - City:ALVORD
Mailing Address - State:TX
Mailing Address - Zip Code:76225-0049
Mailing Address - Country:US
Mailing Address - Phone:940-427-2858
Mailing Address - Fax:940-427-2857
Practice Address - Street 1:115 E BYPASS 287
Practice Address - Street 2:STE A
Practice Address - City:ALVORD
Practice Address - State:TX
Practice Address - Zip Code:76225-7778
Practice Address - Country:US
Practice Address - Phone:940-427-2858
Practice Address - Fax:940-427-2857
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-30
Last Update Date:2016-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX453934OtherMEDICARE
TX175292501Medicaid
TXDF4050OtherRAILROAD MEDICARE
TX111571903Medicaid
TXDF4050OtherRAILROAD MEDICARE
TX453934Medicare Oscar/Certification