Organization
ROCKDALE BLACKHAWK LLC
Active
Organization
ROCKDALE BLACKHAWK LLC
Active
Other names
Little River Healthcare Rockdale Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
JEFFREY P MADISON (CEO)
(512) 446-4500
Entity
Organization
Contact information
Practice address
602 N MAIN ST, ROCKDALE, TX 76567-2323
(512) 446-4500
(512) 446-0084
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
05
—
111705303
—
TX
Enumeration date
07/25/2006
Last updated
02/11/2015
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