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Organization
SPANISH TRACE CLINIC
Active
Organization
SPANISH TRACE CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JERRY B SRTINGFELLOW MD (PROVIDER)
(903) 735-5355
Entity
Organization
Contact information
Practice address
1205 E 35TH ST, TEXARKANA, AR 71854-2746
(903) 735-5355
(903) 735-5399
Mailing address
PO BOX 811, TEXARKANA, TX 75504-0811
(903) 735-5355
(903) 735-5399
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
46KU
BLUE CROSS
TX
01
—
5C286
BLUE CROSS
AR
01
—
CJ8571
RAILROAD MEDICARE
—
Enumeration date
09/08/2005
Last updated
07/21/2022
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