Provider Demographics
NPI:1275710071
Name:GUTHRIE MEDICAL CLINIC INC
Entity Type:Organization
Organization Name:GUTHRIE MEDICAL CLINIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PA
Authorized Official - Prefix:MS
Authorized Official - First Name:LAURE
Authorized Official - Middle Name:L
Authorized Official - Last Name:GUTHRIE
Authorized Official - Suffix:
Authorized Official - Credentials:PA
Authorized Official - Phone:903-454-2453
Mailing Address - Street 1:2706 AILEEN BLVD STE B
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75402-6486
Mailing Address - Country:US
Mailing Address - Phone:903-454-2453
Mailing Address - Fax:903-454-4531
Practice Address - Street 1:2706 AILEEN BLVD STE B
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:TX
Practice Address - Zip Code:75402-6486
Practice Address - Country:US
Practice Address - Phone:903-454-2453
Practice Address - Fax:903-454-4531
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-24
Last Update Date:2008-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA01187363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty