Provider Demographics
NPI:1649267550
Name:OLTON FAMILY HEALTHCARE
Entity type:Organization
Organization Name:OLTON FAMILY HEALTHCARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:WHITE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:806-285-2209
Mailing Address - Street 1:PO BOX 508
Mailing Address - Street 2:600 MAIN STREET
Mailing Address - City:OLTON
Mailing Address - State:TX
Mailing Address - Zip Code:79064-0508
Mailing Address - Country:US
Mailing Address - Phone:806-285-2209
Mailing Address - Fax:806-285-2209
Practice Address - Street 1:600 MAIN ST
Practice Address - Street 2:
Practice Address - City:OLTON
Practice Address - State:TX
Practice Address - Zip Code:79064-0508
Practice Address - Country:US
Practice Address - Phone:806-285-2209
Practice Address - Fax:806-285-2209
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-05
Last Update Date:2010-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0096KYOtherBLUE CROSS BLUE SHIELD OF TEXAS
TX164499902Medicaid
TX164499901Medicaid
TX164499902Medicaid
TX0096KYOtherBLUE CROSS BLUE SHIELD OF TEXAS