Provider Demographics
NPI:1952967846
Name:CLEBURNE FAMILY CARE, LLC
Entity Type:Organization
Organization Name:CLEBURNE FAMILY CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FAMILY NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:EDUY
Authorized Official - Middle Name:J
Authorized Official - Last Name:JAMES
Authorized Official - Suffix:
Authorized Official - Credentials:APRN, FNP-C
Authorized Official - Phone:682-597-6142
Mailing Address - Street 1:128 S. RIDGEWAY DRIVE
Mailing Address - Street 2:
Mailing Address - City:CLEBORNE
Mailing Address - State:TX
Mailing Address - Zip Code:76033
Mailing Address - Country:US
Mailing Address - Phone:682-597-6142
Mailing Address - Fax:817-556-0856
Practice Address - Street 1:128 S. RIDGEWAY DRIVE
Practice Address - Street 2:
Practice Address - City:CLEBORNE
Practice Address - State:TX
Practice Address - Zip Code:76033
Practice Address - Country:US
Practice Address - Phone:682-597-6142
Practice Address - Fax:817-556-0856
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-15
Last Update Date:2020-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care