Organization
INTERSTATE CLINIC LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RANDALL DALE HENDERSON DO (OWNER)
(254) 707-0095
Entity
Organization
Contact information
Practice address
210 N BOSQUE ST, WHITNEY, TX 76692-2416
(254) 221-4342
(254) 221-7051
Mailing address
PO BOX 1400, WHITNEY, TX 76692-1400
(254) 707-0095
(800) 257-1471
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
—
—
Other
Enumeration date
02/10/2020
Last updated
08/27/2020
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