Provider Demographics
NPI:1154150514
Name:MEDICAL MENTORS OF TEXAS
Entity type:Organization
Organization Name:MEDICAL MENTORS OF TEXAS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHARLOTTE
Authorized Official - Middle Name:
Authorized Official - Last Name:HOLIDAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:936-202-7461
Mailing Address - Street 1:PO BOX 546
Mailing Address - Street 2:
Mailing Address - City:PLANTERSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:77363-0546
Mailing Address - Country:US
Mailing Address - Phone:936-202-7461
Mailing Address - Fax:
Practice Address - Street 1:15142 HWY 105 E.
Practice Address - Street 2:STE. A
Practice Address - City:PLANTERSVILLE
Practice Address - State:TX
Practice Address - Zip Code:77363
Practice Address - Country:US
Practice Address - Phone:936-202-7461
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-01
Last Update Date:2024-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health