Provider Demographics
NPI:1649497769
Name:MEDICAL CARE CENTER
Entity type:Organization
Organization Name:MEDICAL CARE CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:C
Authorized Official - Last Name:SHAUF
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:940-665-0736
Mailing Address - Street 1:301 N GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:76240-4321
Mailing Address - Country:US
Mailing Address - Phone:940-665-0736
Mailing Address - Fax:940-668-8637
Practice Address - Street 1:301 N GRAND AVE
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:TX
Practice Address - Zip Code:76240-4321
Practice Address - Country:US
Practice Address - Phone:940-665-0736
Practice Address - Fax:940-668-8637
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE2352207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXD79649Medicare UPIN
TX00P522Medicare ID - Type UnspecifiedMEDICARE PROV #