Provider Demographics
NPI:1427348168
Name:AVERE HEALTHCARE CLINICS LLC
Entity type:Organization
Organization Name:AVERE HEALTHCARE CLINICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:MISS
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:
Authorized Official - Last Name:HEDTKE
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:817-891-8356
Mailing Address - Street 1:2535 CHARLOTTE ST
Mailing Address - Street 2:SUITE 102
Mailing Address - City:DENTON
Mailing Address - State:TX
Mailing Address - Zip Code:76201-3301
Mailing Address - Country:US
Mailing Address - Phone:940-387-7300
Mailing Address - Fax:940-387-1848
Practice Address - Street 1:2535 CHARLOTTE ST
Practice Address - Street 2:SUITE 102
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76201-3301
Practice Address - Country:US
Practice Address - Phone:940-387-7300
Practice Address - Fax:940-387-1848
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-14
Last Update Date:2024-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261Q00000X
TX675701363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/CenterGroup - Single Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1427348168Medicare NSC
TX1417999848Medicare NSC