Organization
CHINA COMMUNITY CLINIC,LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. CHARLES WILLIAM HALL PAC (MANAGER/PAC)
(409) 752-2301
Entity
Organization
Contact information
Practice address
415 N BROADWAY, CHINA, TX 77613
(409) 752-2301
(409) 752-5054
Mailing address
PO BOX 786, CHINA, TX 77613-0786
(409) 752-2301
(409) 752-2301
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
F2352
TX
363AM0700X
Medical Physician Assistant
PA01495
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0033JQ
CCC BCBS GROUP #
TX
01
—
880660
BCBS # CLINIC
TX
01
—
8H1480
MENDOZA BCBS #
TX
01
—
8N3373
CHUCK HALL BCBS #
TX
Enumeration date
09/16/2005
Last updated
09/11/2025
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