Provider Demographics
NPI:1396326294
Name:YOUR HEALTH CLINIC
Entity type:Organization
Organization Name:YOUR HEALTH CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:GWYNNE
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:PALMORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:903-891-1972
Mailing Address - Street 1:PO BOX 69
Mailing Address - Street 2:
Mailing Address - City:SHERMAN
Mailing Address - State:TX
Mailing Address - Zip Code:75091-0069
Mailing Address - Country:US
Mailing Address - Phone:903-891-1972
Mailing Address - Fax:903-487-2482
Practice Address - Street 1:1521 BAKER RD STE 200
Practice Address - Street 2:
Practice Address - City:SHERMAN
Practice Address - State:TX
Practice Address - Zip Code:75090-2409
Practice Address - Country:US
Practice Address - Phone:903-891-1972
Practice Address - Fax:903-487-2482
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:YOUR HEALTH CLINIC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-04-21
Last Update Date:2021-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy