Basic Information
| Provider Information | |||||||||
| NPI: | 1235175357 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | CROSS TIMBERS HEALTH CLINICS, INC. | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | ACCELHEALTH | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1100 W REYNOSA AVE | ||||||||
| Address2: | |||||||||
| City: | DE LEON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 764441630 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 1100 W REYNOSA | ||||||||
| Address2: | |||||||||
| City: | DE LEON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 76444 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2548935895 | ||||||||
| FaxNumber: | 2548935222 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/20/2006 | ||||||||
| LastUpdateDate: | 03/25/2019 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | HILL | ||||||||
| AuthorizedOfficialFirstName: | SHERRY | ||||||||
| AuthorizedOfficialMiddleName: | L | ||||||||
| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 2548935895 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MPA | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QF0400X | Y | Ambulatory Health Care Facilities | Clinic/Center | Federally Qualified Health Center (FQHC) |
ID Information
| ID | Type | State | Issuer | Description | FQ0000018 | 05 | TX | MEDICAID | 4511641 | 01 | OTHER ID NUMBER-COMMERCIAL NUMBER | OTHER |