Provider Demographics
NPI:1982887733
Name:ALICE HEALTH MEDICAL CLINIC
Entity Type:Organization
Organization Name:ALICE HEALTH MEDICAL CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CELSA
Authorized Official - Middle Name:
Authorized Official - Last Name:AGUILAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:361-664-8530
Mailing Address - Street 1:2510 E MAIN ST
Mailing Address - Street 2:SUITE 108
Mailing Address - City:ALICE
Mailing Address - State:TX
Mailing Address - Zip Code:78332-4187
Mailing Address - Country:US
Mailing Address - Phone:361-664-9300
Mailing Address - Fax:
Practice Address - Street 1:2510 E MAIN ST
Practice Address - Street 2:STE. 108
Practice Address - City:ALICE
Practice Address - State:TX
Practice Address - Zip Code:78332-4187
Practice Address - Country:US
Practice Address - Phone:361-664-9300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-14
Last Update Date:2007-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty