Provider Demographics
NPI:1780746339
Name:MEDICAL CENTER
Entity type:Organization
Organization Name:MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:V
Authorized Official - Last Name:MANAX
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:254-694-9400
Mailing Address - Street 1:PO BOX 2570
Mailing Address - Street 2:
Mailing Address - City:WHITNEY
Mailing Address - State:TX
Mailing Address - Zip Code:76692-5570
Mailing Address - Country:US
Mailing Address - Phone:254-694-9400
Mailing Address - Fax:254-694-9175
Practice Address - Street 1:203 A EAST JEFFERSON
Practice Address - Street 2:
Practice Address - City:WHITNEY
Practice Address - State:TX
Practice Address - Zip Code:76692
Practice Address - Country:US
Practice Address - Phone:254-694-9400
Practice Address - Fax:254-694-9175
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF7521305S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX88600YOtherBCBS
TX88600YOtherBCBS
TX8349K0Medicare ID - Type Unspecified