Basic Information
| Provider Information | |||||||||
| NPI: | 1124697784 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | TEXAS QUICK CARE, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 869 | ||||||||
| Address2: | |||||||||
| City: | TIMPSON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 759750869 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9362543338 | ||||||||
| FaxNumber: | 9362543339 | ||||||||
| Practice Location | |||||||||
| Address1: | 507 JACOB ST | ||||||||
| Address2: | |||||||||
| City: | TIMPSON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 759755255 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9362543338 | ||||||||
| FaxNumber: | 9362543339 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/18/2021 | ||||||||
| LastUpdateDate: | 06/18/2021 | ||||||||
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| AuthorizedOfficialLastName: | SPINKS | ||||||||
| AuthorizedOfficialFirstName: | ALANNAH | ||||||||
| AuthorizedOfficialMiddleName: | MICHELLE | ||||||||
| AuthorizedOfficialTitleorPosition: | EXECUTIVE DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 9365538832 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 06/02/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 357792601 | 05 | TX | MEDICAID |