Provider Demographics
NPI:1952563694
Name:CELINA MEDICAL CLINIC
Entity Type:Organization
Organization Name:CELINA MEDICAL CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/NP
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:MYERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-382-3939
Mailing Address - Street 1:701 N PRESTON RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:CELINA
Mailing Address - State:TX
Mailing Address - Zip Code:75009-3763
Mailing Address - Country:US
Mailing Address - Phone:972-382-3939
Mailing Address - Fax:972-382-2211
Practice Address - Street 1:701 N PRESTON RD
Practice Address - Street 2:SUITE 200
Practice Address - City:CELINA
Practice Address - State:TX
Practice Address - Zip Code:75009-3763
Practice Address - Country:US
Practice Address - Phone:972-382-3939
Practice Address - Fax:972-382-2211
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-25
Last Update Date:2008-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX572642363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX611528Medicare UPIN