Provider Demographics
NPI:1821533324
Name:WAL-MART STORES TEXAS, LLC
Entity Type:Organization
Organization Name:WAL-MART STORES TEXAS, LLC
Other - Org Name:WAL-MART CARE CLINIC 10-0351
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SR. MGR, HEALTH & WELLNESS
Authorized Official - Prefix:
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:
Authorized Official - Last Name:LITTLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:479-277-2500
Mailing Address - Street 1:25800 KUYKENDAHL RD
Mailing Address - Street 2:
Mailing Address - City:TOMBALL
Mailing Address - State:TX
Mailing Address - Zip Code:77375-2892
Mailing Address - Country:US
Mailing Address - Phone:832-761-8496
Mailing Address - Fax:281-516-9609
Practice Address - Street 1:25800 KUYKENDAHL RD
Practice Address - Street 2:
Practice Address - City:TOMBALL
Practice Address - State:TX
Practice Address - Zip Code:77375-2892
Practice Address - Country:US
Practice Address - Phone:832-761-8496
Practice Address - Fax:281-516-9609
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WAL-MART STORES, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-12-20
Last Update Date:2017-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty