Basic Information
| Provider Information | |||||||||
| NPI: | 1942543335 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | CLINE FAMILY PRACTICE | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
| MiddleName: | |||||||||
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| OtherOrganizationName: | CLINE FAMILY MEDICINE | ||||||||
| OtherOrganizationType: | 5 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4604 NE STALLINGS DR | ||||||||
| Address2: | |||||||||
| City: | NACOGDOCHES | ||||||||
| State: | TX | ||||||||
| PostalCode: | 759651608 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9365598770 | ||||||||
| FaxNumber: | 9365598773 | ||||||||
| Practice Location | |||||||||
| Address1: | 630 HURST ST | ||||||||
| Address2: | |||||||||
| City: | CENTER | ||||||||
| State: | TX | ||||||||
| PostalCode: | 759353414 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9365598770 | ||||||||
| FaxNumber: | 9365598773 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/03/2013 | ||||||||
| LastUpdateDate: | 02/06/2017 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | FREEMAN | ||||||||
| AuthorizedOfficialFirstName: | KIM | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | OFFICE MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 9365598770 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QP2300X | J8492 | TX | Y | Ambulatory Health Care Facilities | Clinic/Center | Primary Care |
No ID Information.