Provider Demographics
NPI:1770754236
Name:SAVANNAH CLINIC ASSOCIATES LLC
Entity type:Organization
Organization Name:SAVANNAH CLINIC ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LANA
Authorized Official - Middle Name:
Authorized Official - Last Name:RALSTON
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:214-632-3514
Mailing Address - Street 1:26795 US HIGHWAY 380 E
Mailing Address - Street 2:SUITE 100A
Mailing Address - City:AUBREY
Mailing Address - State:TX
Mailing Address - Zip Code:76227-7853
Mailing Address - Country:US
Mailing Address - Phone:972-347-5761
Mailing Address - Fax:972-347-5786
Practice Address - Street 1:26795 US HIGHWAY 380 E
Practice Address - Street 2:SUITE 100A
Practice Address - City:AUBREY
Practice Address - State:TX
Practice Address - Zip Code:76227-7853
Practice Address - Country:US
Practice Address - Phone:972-347-5761
Practice Address - Fax:972-347-5786
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-12
Last Update Date:2009-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty