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Organization
VIDOR COMMUNITY HEALTH CLINIC INC
Active
Organization
VIDOR COMMUNITY HEALTH CLINIC INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LINDA J BOONE APN (PRESIDENT)
(409) 769-7795
Entity
Organization
Contact information
Practice address
1290 HIGHWAY 12, VIDOR, TX 77662-4016
(409) 769-7795
(409) 769-8721
Mailing address
PO BOX 2202, VIDOR, TX 77670-2202
(409) 769-7795
(409) 769-8721
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
561872
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00037H
MEDICARE PART B
TX
05
—
119735203
—
TX
01
—
RU0016
BCBS
TX
Enumeration date
07/30/2006
Last updated
02/19/2010
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