Provider Demographics
NPI:1992395503
Name:TROTT MEMORIAL CLINIC
Entity Type:Organization
Organization Name:TROTT MEMORIAL CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE
Authorized Official - Prefix:
Authorized Official - First Name:CONCEPCION
Authorized Official - Middle Name:
Authorized Official - Last Name:CANTU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:361-293-3553
Mailing Address - Street 1:212 E MORRIS ST
Mailing Address - Street 2:
Mailing Address - City:YOAKUM
Mailing Address - State:TX
Mailing Address - Zip Code:77995-4051
Mailing Address - Country:US
Mailing Address - Phone:361-293-3553
Mailing Address - Fax:
Practice Address - Street 1:212 E MORRIS ST
Practice Address - Street 2:
Practice Address - City:YOAKUM
Practice Address - State:TX
Practice Address - Zip Code:77995-4051
Practice Address - Country:US
Practice Address - Phone:361-293-3553
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-19
Last Update Date:2021-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1558326504Medicaid