Organization
ROCKDALE BLACKHAWK LLC
Active
Other names
Little River Medical Clinic - Rockdale
Organization subpart
No
Provider details
NPI number
Authorized official
JEFF MADISON (CEO)
(512) 446-4500
Entity
Organization
Contact information
Practice address
602 N MAIN ST, ROCKDALE, TX 76567-2323
(512) 446-4555
(512) 446-4533
Mailing address
PO BOX 1010, ROCKDALE, TX 76567-1010
(512) 446-4500
(512) 446-0084
Taxonomy
Speciality
Code
Description
License number
State
261QR1300X
Rural Health Clinic/Center
Primary
000369
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00X082
MEDICARE GROUP
TX
05
—
186695601
—
TX
Enumeration date
04/18/2007
Last updated
04/09/2015
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