Provider Demographics
NPI:1104957877
Name:R H FAMILY MEDICAL CLINIC
Entity type:Organization
Organization Name:R H FAMILY MEDICAL CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INSURANCE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:YVONNE
Authorized Official - Last Name:JIMENEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:915-591-8818
Mailing Address - Street 1:9398 VISCOUNT BLVD STE 1B
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79925-8028
Mailing Address - Country:US
Mailing Address - Phone:915-591-8818
Mailing Address - Fax:915-591-7882
Practice Address - Street 1:9398 VISCOUNT BLVD STE 1B
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79925-8028
Practice Address - Country:US
Practice Address - Phone:915-591-8818
Practice Address - Fax:915-591-7882
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL9735207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXI17445Medicare UPIN