Provider Demographics
NPI:1508071697
Name:COMANCHE FAMILY CLINIC LLC
Entity Type:Organization
Organization Name:COMANCHE FAMILY CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:RACHEL
Authorized Official - Middle Name:N
Authorized Official - Last Name:HILLIARD
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:325-325-7530
Mailing Address - Street 1:105 VALLEY FORGE ST
Mailing Address - Street 2:
Mailing Address - City:COMANCHE
Mailing Address - State:TX
Mailing Address - Zip Code:76442-1813
Mailing Address - Country:US
Mailing Address - Phone:325-356-7530
Mailing Address - Fax:325-356-5388
Practice Address - Street 1:105 VALLEY FORGE ST
Practice Address - Street 2:
Practice Address - City:COMANCHE
Practice Address - State:TX
Practice Address - Zip Code:76442-1813
Practice Address - Country:US
Practice Address - Phone:325-356-7530
Practice Address - Fax:325-356-5388
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX607586363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP87070Medicare UPIN