Sudan Medical Clinic, Llc in Sudan - Physician Assistant
Sudan Medical Clinic, Llc - NPI 1215942073
Sudan Medical Clinic, Llc is a Physician Assistant in Sudan, Texas. Sudan Medical Clinic, Llc practices all healthcare services and medical treatments related to Physician Assistant. The NPI Number for Sudan Medical Clinic, Llc is 1215942073. The last update date is 2021-04-12.
Sudan Medical Clinic, Llc's current location address is Po Box 119, Sudan, Texas. You can contact this provider via phone number 8062272292 and fax number 8062272293. The mailing address for Sudan Medical Clinic, Llc is Po Box 119, Sudan, Texas. To know further, please read the information below!
Provider Profile Detail
| Provider Organization | Sudan Medical Clinic, Llc |
|---|---|
| Address | Po Box 119, Sudan, Texas |
| Phone Number | 8062272292 |
| Fax Number | 8062272293 |
| Sole Proprietor | -- |
| Credentials | -- |
Authorized Official
| Title or Position | PRESIDENT/ |
|---|---|
| Authorized Official Name | Mcclanahan Lee Mark |
| Credentials | D.O. |
| Telephone Number | 8062272292 |
NPI Number Detail
| NPI Number | 1215942073 |
|---|---|
| Provider Enumeration Date | 2006-07-30 |
| Last Updated Date | 2021-04-12 |
Provider Mailing Address Detail
| Address | Po Box 119 |
|---|---|
| City | Sudan |
| State | Texas (TX) |
| Post Code | 793710119 |
| Phone Number | 8062272292 |
| Fax Number | 8062272293 |
Provider's Primary Taxonomy Detail
| Speciality | Physician Assistant |
|---|---|
| Taxonomy | 363A00000X |
| Licence No | PA02006 |
|
Definition: A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perfor |
|
Provider's Other Legacy Identifiers
| Identifier | Identifier Type | Identifier State | Identifier Issuer |
|---|---|---|---|
| 118927111 | TX | FIRST CARE | |
| 00963Z | MEDICARE | ||
| 137527 | TX | SUPERIOR HEALTH PLAN | |
| 178241901 | TX | -- | |
| 178241902 | TX | -- | |
| 0074NH | TX | BLUE CROSS BLUE SHIELD | |
| 673950 | TX | MEDICARE | |
| 673951 | TX | MEDICARE | |
| 5594300001 | TX | PALMETTO GBA |
Post Comment/ Review Below
What is the unique identifier code issued to Sudan Medical Clinic, Llc by the Centers for Medicare & Medicaid Services?
The Sudan Medical Clinic, Llc has been assigned the NPI (National Provider Identifier) 1215942073. This 10-digit code serves as a unique identification number for healthcare providers issued by the Centers for Medicare & Medicaid Services (CMS).
Could you provide the complete address where Sudan Medical Clinic, Llc is physically located?
The Sudan Medical Clinic, Llc is situated at the following address: Po Box 119, Sudan, TX 793710119.
What is Sudan Medical Clinic, Llc's area of expertise and its corresponding taxonomy classification?
The Sudan Medical Clinic, Llc's field of specialization is Physician Assistant, and it falls under the taxonomy code 363A00000X, which categorizes healthcare providers based on their areas of practice.
On what date did the Centers for Medicare & Medicaid Services issue the 1215942073 to Sudan Medical Clinic, Llc?
The Sudan Medical Clinic, Llc received its 1215942073 assignment from the Centers for Medicare & Medicaid Services on 2006-07-30.
When was the information regarding Sudan Medical Clinic, Llc most recently updated?
The details pertaining to the Sudan Medical Clinic, Llc, including its address, specialty, and other relevant information, were last refreshed on 2021-04-12.