Provider Demographics
NPI:1386984508
Name:SHELBY FAMILY CLINIC
Entity type:Organization
Organization Name:SHELBY FAMILY CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:FLORENCIO
Authorized Official - Middle Name:
Authorized Official - Last Name:SINGSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:936-598-2933
Mailing Address - Street 1:602 HURST ST
Mailing Address - Street 2:SUITE 3
Mailing Address - City:CENTER
Mailing Address - State:TX
Mailing Address - Zip Code:75935-3414
Mailing Address - Country:US
Mailing Address - Phone:936-598-2933
Mailing Address - Fax:
Practice Address - Street 1:602 HURST ST
Practice Address - Street 2:SUITE 3
Practice Address - City:CENTER
Practice Address - State:TX
Practice Address - Zip Code:75935-3414
Practice Address - Country:US
Practice Address - Phone:936-598-2933
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-25
Last Update Date:2013-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG4713261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX133358503Medicaid
TXB26476Medicare UPIN