Provider Demographics
NPI:1366583890
Name:MINOR CARE CLINIC OF TEXARKANA
Entity type:Organization
Organization Name:MINOR CARE CLINIC OF TEXARKANA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXEC DIRECTOR OPERATIONS
Authorized Official - Prefix:MS
Authorized Official - First Name:DELORES
Authorized Official - Middle Name:
Authorized Official - Last Name:BALDWIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-277-2201
Mailing Address - Street 1:2604 ST MICHAEL'S DRIVE
Mailing Address - Street 2:SUITE 238
Mailing Address - City:TEXARKANA
Mailing Address - State:TX
Mailing Address - Zip Code:75503
Mailing Address - Country:US
Mailing Address - Phone:903-614-7800
Mailing Address - Fax:903-614-7805
Practice Address - Street 1:2604 ST MICHAEL'S DRIVE
Practice Address - Street 2:SUITE 238
Practice Address - City:TEXARKANA
Practice Address - State:TX
Practice Address - Zip Code:75503
Practice Address - Country:US
Practice Address - Phone:903-614-7800
Practice Address - Fax:903-614-7805
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty