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Contact Information

SHEPHERD RURAL HEALTH CLINIC PA
11 WOODLAND PARK DRIVE
SHEPHERD, TX77371
 Phone: 936-628-3343
 Fax:
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Physician Assistant

363A00000X 97 Physician Assistant
Indicates primary specialty

NPI Profile & details for SHEPHERD RURAL HEALTH CLINIC PA

NPI # 1376629212
LBN Legal business name SHEPHERD RURAL HEALTH CLINIC PA
Authorized official PHILIP WISIACKAS - (PHYSICIAN)
Entity Organization
Organization subpart 1 No
Enumeration date 10/31/2006
Last updated 08/30/2010 - About 16 years ago
Identifiers
TX License # F4703
TX Medicaid 130767003
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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