Basic Information
| Provider Information | |||||||||
| NPI: | 1083862379 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | PANHANDLE FAMILY CARE LLC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | FAMILY CARE CLINIC OF CLAUDE | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 201 PARKS ST | ||||||||
| Address2: | |||||||||
| City: | CLAUDE | ||||||||
| State: | TX | ||||||||
| PostalCode: | 790193868 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8066404215 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 201 PARKS ST | ||||||||
| Address2: | |||||||||
| City: | CLAUDE | ||||||||
| State: | TX | ||||||||
| PostalCode: | 790193868 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8062265611 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/29/2008 | ||||||||
| LastUpdateDate: | 07/26/2019 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | JEFFREYS | ||||||||
| AuthorizedOfficialFirstName: | HOLLY | ||||||||
| AuthorizedOfficialMiddleName: | L | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 8066404215 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | PANHANDLE FAMILY CARE LLC | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QR1300X | Y | Ambulatory Health Care Facilities | Clinic/Center | Rural Health |
ID Information
| ID | Type | State | Issuer | Description | 200790801 | 05 | TX | MEDICAID |