Provider Demographics
NPI:1831270693
Name:MEXIA PRINCIPAL HEALTHCARE LIMITD PARTNERSHIP
Entity type:Organization
Organization Name:MEXIA PRINCIPAL HEALTHCARE LIMITD PARTNERSHIP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:M
Authorized Official - Last Name:GRACEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-372-8500
Mailing Address - Street 1:103 POWELL CT
Mailing Address - Street 2:STE. 200
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-5079
Mailing Address - Country:US
Mailing Address - Phone:615-372-8500
Mailing Address - Fax:615-337-2857
Practice Address - Street 1:HIGHWAY 84 AT 8TH AVE.
Practice Address - Street 2:
Practice Address - City:TEAGUE
Practice Address - State:TX
Practice Address - Zip Code:75860
Practice Address - Country:US
Practice Address - Phone:254-739-5090
Practice Address - Fax:254-739-5666
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MEXIA PRINCIPAL HEALTHCARE LIMITD PARTNERSHIP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-10-18
Last Update Date:2008-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX173417001Medicaid
458857Medicare ID - Type UnspecifiedRURAL HEALTH CLINIC