Provider Demographics
NPI:1366697864
Name:RONALD BACANI PRIMARY CARE CLINIC AND URGENT CARE, LLC
Entity type:Organization
Organization Name:RONALD BACANI PRIMARY CARE CLINIC AND URGENT CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FNP/PRIMARY CARE PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:CASTRO
Authorized Official - Last Name:BACANI
Authorized Official - Suffix:
Authorized Official - Credentials:FNP-C
Authorized Official - Phone:432-332-0728
Mailing Address - Street 1:PO BOX 3186
Mailing Address - Street 2:
Mailing Address - City:ODESSA
Mailing Address - State:TX
Mailing Address - Zip Code:79760-3186
Mailing Address - Country:US
Mailing Address - Phone:432-332-0728
Mailing Address - Fax:
Practice Address - Street 1:621 NORTH WAHINGTON ST.
Practice Address - Street 2:
Practice Address - City:ODESSA
Practice Address - State:TX
Practice Address - Zip Code:79761-5034
Practice Address - Country:US
Practice Address - Phone:432-332-0728
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-25
Last Update Date:2009-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX639134363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty