Provider Demographics
NPI:1215075734
Name:PLAINVIEW FOUNDATION FOR RURAL HEALTH ADVANCEMENT
Entity type:Organization
Organization Name:PLAINVIEW FOUNDATION FOR RURAL HEALTH ADVANCEMENT
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:RETTA
Authorized Official - Middle Name:
Authorized Official - Last Name:KNOX
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:806-938-2299
Mailing Address - Street 1:708 SECOND STREET
Mailing Address - Street 2:P.O. BOX 727
Mailing Address - City:HART
Mailing Address - State:TX
Mailing Address - Zip Code:79043
Mailing Address - Country:US
Mailing Address - Phone:806-938-2299
Mailing Address - Fax:806-938-2299
Practice Address - Street 1:708 SECOND STREET
Practice Address - Street 2:P.O. 727
Practice Address - City:HART
Practice Address - State:TX
Practice Address - Zip Code:79043
Practice Address - Country:US
Practice Address - Phone:806-938-2299
Practice Address - Fax:806-938-2299
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PLAINVIEW FOUNDATION FOR RURAL HEALTH ADVNCEMENT
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-02-05
Last Update Date:2009-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX004447106H00000X
TX15727122300000X
TX14975122300000X
TX0009405124Q00000X
TX222624163W00000X
TXK7364207Q00000X
TXJ2653208000000X
TXJ8480208000000X
TXJ5095208000000X
TXL5161208000000X
TXD6154208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
No122300000XDental ProvidersDentistGroup - Multi-Specialty
No124Q00000XDental ProvidersDental HygienistGroup - Multi-Specialty
No163W00000XNursing Service ProvidersRegistered NurseGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX091324602Medicaid
TX192116501Medicaid
TX192116502Medicaid
TX091324601Medicaid
TX091324603Medicaid
TX192116503Medicaid