Organization
DEWITT MEDICAL DISTRICT
Active
Other names
Parkside Family Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
LYNN FALCONE (ADMINISTRATOR/CEO)
(361) 275-6191
Entity
Organization
Contact information
Practice address
1109 E BROADWAY ST, CUERO, TX 77954-2108
(361) 275-2800
(361) 275-8791
Mailing address
1109 E BROADWAY ST, CUERO, TX 77954-2108
(361) 275-2800
(361) 275-8791
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
—
—
261QR1300X
Rural Health Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
344242801
—
TX
05
—
350897001
—
TX
05
—
350897002
—
TX
Enumeration date
08/21/2014
Last updated
08/18/2022
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