INTERSTATE CLINIC LLC NPI 1003448770

Clinic/Center (Primary Care) in Whitney, TX

Organization Clinic/Center Primary Care

About INTERSTATE CLINIC LLC

Interstate Clinic Llc is a provider established in Whitney, Texas specializing in clinic/center. The NPI number of Interstate Clinic Llc is 1003448770 and was assigned on February 2020. The practitioner's primary taxonomy code is 261QP2300X. The provider is registered as an organization and their NPI record was last updated February 2020. The authorized official of this NPI record is Dr. Randall Dale Henderson Do (Owner)

NPI

1003448770

Provider NameINTERSTATE CLINIC LLC
Provider Location Address210 N BOSQUE ST WHITNEY, TX 76692
Provider Mailing AddressPO BOX 1400 WHITNEY, TX 76692
NPI Entity TypeOrganization
Is Sole Proprietor?N/A
Is Organization Subpart?No
Enumeration Date02-10-2020
Last Update Date02-10-2020

Primary Taxonomy

Taxonomy Code261QP2300X
ClassificationClinic/Center
TypeAmbulatory Health Care Facilities
SpecializationPrimary Care

Business Address

INTERSTATE CLINIC LLC
210 N BOSQUE ST
WHITNEY, TX
ZIP 76692
Phone: (254) 707-0095
Fax: (800) 257-1471

Get Directions

Mailing Address

INTERSTATE CLINIC LLC
PO BOX 1400
WHITNEY, TX
ZIP 76692
Phone: (254) 707-0095
Fax: (800) 257-1471

Authorized Official

Authorized Official NameDR. RANDALL DALE HENDERSON DO
Authorized Official TitleOWNER
Authorized Official Phone(254) 707-0095

NPI Footnotes

What is the National Provider Indentifier (NPI)?
The NPI is 10-position all-numeric identification number assigned by the NPPES to uniquely identify a health care provider.

Provider Location Address
The location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.

Provider Mailing Address
The mailing address of the provider being identified. This address may contain the same information as the provider location address.

Entity Type Code
The code describing the type of health care provider that is being assigned an NPI.
The entity type codes are:
1 = Person: individual human being who furnishes health care;
2 = Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)

What is a Subpart?
Subparts are the components and separate physical locations of organization health care providers. Subpart examples include:
Hospital components include outpatient departments, surgical centers, psychiatric units, and laboratories. These components are often separately licensed or certified by States and may exist at physical locations other than that of the hospital of which they are a component.

Provider Other Organization Name
The other organization name is the alternative last name by which the provider is or has been known (if an individual) or other name by which the organization provider is or has been known. The code identifying the type of other name. The provider other organization name codes are:
1 = former name;
2 = professional name;
3 = doing business as (d/b/ a) name;
4 = former legal business name; :
5 = other.

Provider Enumeration Date
The date the provider was assigned a unique identifier (assigned an NPI).

Last Update Date
The date that a NPI record was last updated or changed.

Primary Taxonomy Code
The primary taxonomy code defines the provider type, classification, and specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.

Authorized Official Name
The name of the person authorized to submit the NPI application or to officially change data for a health care provider.