Provider Demographics
NPI:1023099546
Name:THE EAGLE FORD CLINICS, PA
Entity type:Organization
Organization Name:THE EAGLE FORD CLINICS, PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SURESH
Authorized Official - Middle Name:V
Authorized Official - Last Name:DUTTA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:830-965-1684
Mailing Address - Street 1:111 E MILLER ST
Mailing Address - Street 2:
Mailing Address - City:DILLEY
Mailing Address - State:TX
Mailing Address - Zip Code:78017-3912
Mailing Address - Country:US
Mailing Address - Phone:830-965-1684
Mailing Address - Fax:830-965-1278
Practice Address - Street 1:111 E MILLER ST
Practice Address - Street 2:
Practice Address - City:DILLEY
Practice Address - State:TX
Practice Address - Zip Code:78017-3912
Practice Address - Country:US
Practice Address - Phone:830-965-1684
Practice Address - Fax:830-965-1278
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-10
Last Update Date:2015-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX13506605Medicaid
TX135106603OtherTX HEALTH STEPS
TX453860Medicare PIN