Provider Demographics
NPI:1952433310
Name:P S WELL-CHILD CLINIC
Entity type:Organization
Organization Name:P S WELL-CHILD CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:PAULA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:SNOKHOUS
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:254-826-3865
Mailing Address - Street 1:407 W OAK ST
Mailing Address - Street 2:P.O. BOX 458
Mailing Address - City:WEST
Mailing Address - State:TX
Mailing Address - Zip Code:76691
Mailing Address - Country:US
Mailing Address - Phone:254-826-3865
Mailing Address - Fax:254-826-7071
Practice Address - Street 1:407 W OAK ST.
Practice Address - Street 2:
Practice Address - City:WEST
Practice Address - State:TX
Practice Address - Zip Code:76691
Practice Address - Country:US
Practice Address - Phone:254-826-3865
Practice Address - Fax:254-826-7071
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-12
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA02665207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX092036501Medicaid
TX092036502Medicaid
TX00701NMedicare PIN