Provider Demographics
NPI:1437991973
Name:FIRM FOUNDATIONS HEALTHCARE CLINIC PC
Entity type:Organization
Organization Name:FIRM FOUNDATIONS HEALTHCARE CLINIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:JANEL
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:RT(R)
Authorized Official - Phone:936-334-8800
Mailing Address - Street 1:2708 JEFFERSON DR
Mailing Address - Street 2:STE A
Mailing Address - City:LIBERTY
Mailing Address - State:TX
Mailing Address - Zip Code:77575-1036
Mailing Address - Country:US
Mailing Address - Phone:936-334-8800
Mailing Address - Fax:936-334-8801
Practice Address - Street 1:2708 JEFFERSON DR
Practice Address - Street 2:STE A
Practice Address - City:LIBERTY
Practice Address - State:TX
Practice Address - Zip Code:77575-1036
Practice Address - Country:US
Practice Address - Phone:936-334-8800
Practice Address - Fax:936-334-8801
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-06
Last Update Date:2024-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health