Provider Demographics
NPI:1306119490
Name:REGIONAL HEALTH CLINIC AT TERRELL PLLC
Entity type:Organization
Organization Name:REGIONAL HEALTH CLINIC AT TERRELL PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:DR
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:W
Authorized Official - Last Name:HAMBERLIN
Authorized Official - Suffix:
Authorized Official - Credentials:NP-C, DC
Authorized Official - Phone:972-563-1475
Mailing Address - Street 1:PO BOX 1866
Mailing Address - Street 2:
Mailing Address - City:TERRELL
Mailing Address - State:TX
Mailing Address - Zip Code:75160-0033
Mailing Address - Country:US
Mailing Address - Phone:972-563-1475
Mailing Address - Fax:972-524-5132
Practice Address - Street 1:1553 STATE HIGHWAY 34 S
Practice Address - Street 2:STE 100
Practice Address - City:TERRELL
Practice Address - State:TX
Practice Address - Zip Code:75160-4833
Practice Address - Country:US
Practice Address - Phone:972-563-1475
Practice Address - Fax:972-524-5132
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-20
Last Update Date:2013-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX774755261QP2300X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXTXB156510Medicare PIN