Provider Demographics
NPI:1982972402
Name:DENTON COMMUNITY HEALTH CLINIC
Entity Type:Organization
Organization Name:DENTON COMMUNITY HEALTH CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:ALICE
Authorized Official - Last Name:MASCIARELLI
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:940-600-7527
Mailing Address - Street 1:525 S LOCUST ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:DENTON
Mailing Address - State:TX
Mailing Address - Zip Code:76201-6023
Mailing Address - Country:US
Mailing Address - Phone:940-600-7527
Mailing Address - Fax:940-383-1251
Practice Address - Street 1:525 S LOCUST ST
Practice Address - Street 2:SUITE 200
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76201-6023
Practice Address - Country:US
Practice Address - Phone:940-600-7527
Practice Address - Fax:940-383-1251
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-12
Last Update Date:2013-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX319434201Medicaid
TXTXB164520Medicare PIN