Provider Demographics
NPI:1760824387
Name:BLANCO REGIONAL CLINIC
Entity Type:Organization
Organization Name:BLANCO REGIONAL CLINIC
Other - Org Name:JOHNSON CITY MEDICAL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:EILERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:830-456-6310
Mailing Address - Street 1:825 4TH ST
Mailing Address - Street 2:
Mailing Address - City:BLANCO
Mailing Address - State:TX
Mailing Address - Zip Code:78606-4913
Mailing Address - Country:US
Mailing Address - Phone:830-833-5581
Mailing Address - Fax:830-833-4933
Practice Address - Street 1:405 S US HIGHWAY 281
Practice Address - Street 2:
Practice Address - City:JOHNSON CITY
Practice Address - State:TX
Practice Address - Zip Code:78636-4950
Practice Address - Country:US
Practice Address - Phone:830-833-5581
Practice Address - Fax:830-833-4933
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-24
Last Update Date:2013-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty