Provider Demographics
NPI:1942572227
Name:EASTLAND HEALTH CLINIC PLLC
Entity Type:Organization
Organization Name:EASTLAND HEALTH CLINIC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FAMILY NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:BERENDA
Authorized Official - Last Name:STEWART
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:254-631-0111
Mailing Address - Street 1:PO BOX 150415
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78715-0415
Mailing Address - Country:US
Mailing Address - Phone:254-631-0111
Mailing Address - Fax:254-631-0186
Practice Address - Street 1:1004 W MAIN ST
Practice Address - Street 2:
Practice Address - City:EASTLAND
Practice Address - State:TX
Practice Address - Zip Code:76448-2432
Practice Address - Country:US
Practice Address - Phone:254-631-0111
Practice Address - Fax:254-631-0186
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-02
Last Update Date:2012-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX653723261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care