Provider Demographics
NPI:1750573416
Name:SLATON FAMILY MEDICAL, PLLC.
Entity type:Organization
Organization Name:SLATON FAMILY MEDICAL, PLLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:AL
Authorized Official - Middle Name:
Authorized Official - Last Name:BENDECK
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:806-828-1600
Mailing Address - Street 1:PO BOX 54136
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79453-4136
Mailing Address - Country:US
Mailing Address - Phone:806-771-1386
Mailing Address - Fax:806-771-1388
Practice Address - Street 1:235 W GARZA ST
Practice Address - Street 2:SUITE B
Practice Address - City:SLATON
Practice Address - State:TX
Practice Address - Zip Code:79364-4127
Practice Address - Country:US
Practice Address - Phone:806-828-1600
Practice Address - Fax:806-828-1610
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-15
Last Update Date:2013-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX210889601Medicaid
TX673911Medicare Oscar/Certification