Organization
ROCKDALE BLACKHAWK, LLC
Active
Other names
Little River Medical Clinic - Hearne
Organization subpart
No
Provider details
NPI number
Authorized official
SHANA DAVENPORT (INSURANCE CREDENTIALING SUPERVISOR)
(512) 446-4500
Entity
Organization
Contact information
Practice address
104 S MAGNOLIA ST, HEARNE, TX 77859-2565
(979) 280-0022
(979) 280-0023
Mailing address
PO BOX 1010, ROCKDALE, TX 76567-1010
(512) 446-4500
(512) 446-2063
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
—
—
Other
Enumeration date
07/31/2007
Last updated
02/08/2008
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