Organization
PARK CLINIC PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. FAUSTO AVILA MD (SECT TREASURE)
(940) 592-4141
Entity
Organization
Contact information
Practice address
310 W ALAMEDA, IOWA PARK, TX 76367-1600
(940) 592-4141
(940) 592-4842
Mailing address
P O BOX 639, IOWA PARK, TX 76367-1639
(940) 592-4141
(940) 592-4842
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1115859
—
TX
Enumeration date
09/11/2006
Last updated
08/22/2020
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