Organization
CISCO MEDICAL CLINIC, P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CHARLES NEVIN STEPHENSON P.A. (P. A.)
(254) 442-1441
Entity
Organization
Contact information
Practice address
1619 HIGHWAY 206, CISCO, TX 76437-6447
(254) 442-1441
(254) 442-1466
Mailing address
1619 HIGHWAY 206, CISCO, TX 76437-6447
(254) 442-1441
(254) 442-1466
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA00390
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PA00390
PA NUMBER
TX
Enumeration date
12/05/2006
Last updated
08/22/2020
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