| Interstate Clinic LLC | |
|
210 N Bosque St Whitney TX 76692-2416 | |
| (254) 221-4342 | |
| (254) 221-7051 |
| Full Name | Interstate Clinic LLC |
|---|---|
| Speciality | Clinic/center - Primary Care |
| Location | 210 N Bosque St, Whitney, Texas |
| Authorized Official Name and Position | Randall Dale Henderson (OWNER) |
| Authorized Official Contact | 2547070095 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Interstate Clinic LLC Po Box 1400 Whitney TX 76692-1400 Ph: (254) 707-0095 | Interstate Clinic LLC 210 N Bosque St Whitney TX 76692-2416 Ph: (254) 221-4342 |
| NPI Number | 1003448770 |
|---|---|
| Provider Enumeration Date | 02/10/2020 |
| Last Update Date | 08/27/2020 |
| Certification Date | 08/19/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1003448770 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | () | Primary |
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