Provider Demographics
NPI:1841528130
Name:WATERFALLS MEDICAL CLINIC INC.
Entity type:Organization
Organization Name:WATERFALLS MEDICAL CLINIC INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:GLENDA
Authorized Official - Middle Name:MARITZA
Authorized Official - Last Name:QUINTEROZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-300-6213
Mailing Address - Street 1:111 W ANDERSON LN
Mailing Address - Street 2:SUITE D217 A
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78752-1132
Mailing Address - Country:US
Mailing Address - Phone:512-420-8195
Mailing Address - Fax:
Practice Address - Street 1:111 W ANDERSON LN
Practice Address - Street 2:SUITE D217 A
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78752-1132
Practice Address - Country:US
Practice Address - Phone:512-420-8195
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-24
Last Update Date:2009-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX6180261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX6180OtherCHIROPRACTIC