Provider Demographics
NPI:1720318744
Name:LITTLE DONKEY HEALTH SERVICES INC.
Entity Type:Organization
Organization Name:LITTLE DONKEY HEALTH SERVICES INC.
Other - Org Name:ALTON FAMILY CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:HECTOR
Authorized Official - Middle Name:
Authorized Official - Last Name:RODRIGUEZ
Authorized Official - Suffix:III
Authorized Official - Credentials:FNP
Authorized Official - Phone:956-580-9950
Mailing Address - Street 1:3509 E MAIN AVE
Mailing Address - Street 2:STE 101
Mailing Address - City:ALTON
Mailing Address - State:TX
Mailing Address - Zip Code:78573-1561
Mailing Address - Country:US
Mailing Address - Phone:956-580-9950
Mailing Address - Fax:956-580-9953
Practice Address - Street 1:3509 E MAIN AVE
Practice Address - Street 2:STE 101
Practice Address - City:ALTON
Practice Address - State:TX
Practice Address - Zip Code:78573-1561
Practice Address - Country:US
Practice Address - Phone:956-580-9950
Practice Address - Fax:956-580-9953
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-14
Last Update Date:2011-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX2176547Medicaid