Provider Demographics
NPI:1669515631
Name:SEAGRAVES FAMILY CLINIC
Entity type:Organization
Organization Name:SEAGRAVES FAMILY CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:CLIFTON
Authorized Official - Middle Name:DANE
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:MPAS, PAC, LP
Authorized Official - Phone:806-387-3325
Mailing Address - Street 1:302 MAIN
Mailing Address - Street 2:BOX 1355
Mailing Address - City:SEAGRAVES
Mailing Address - State:TX
Mailing Address - Zip Code:79359-0000
Mailing Address - Country:US
Mailing Address - Phone:806-387-3325
Mailing Address - Fax:
Practice Address - Street 1:302 MAIN
Practice Address - Street 2:BOX 1355
Practice Address - City:SEAGRAVES
Practice Address - State:TX
Practice Address - Zip Code:79359-0000
Practice Address - Country:US
Practice Address - Phone:806-387-3325
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-15
Last Update Date:2008-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0074PLOtherBLUECROSS BLUESHIELD
TX00Y0836Medicare PIN