Provider Demographics
NPI:1528451101
Name:TALL CITY CONVENIENT PRIMARY CARE
Entity type:Organization
Organization Name:TALL CITY CONVENIENT PRIMARY CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:D
Authorized Official - Last Name:TALLEY
Authorized Official - Suffix:
Authorized Official - Credentials:FNP-C
Authorized Official - Phone:432-352-4443
Mailing Address - Street 1:4519 N GARFIELD ST
Mailing Address - Street 2:SUITE 6
Mailing Address - City:MIDLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79705-3415
Mailing Address - Country:US
Mailing Address - Phone:432-352-4443
Mailing Address - Fax:
Practice Address - Street 1:4519 N GARFIELD ST
Practice Address - Street 2:SUITE 6
Practice Address - City:MIDLAND
Practice Address - State:TX
Practice Address - Zip Code:79705-3415
Practice Address - Country:US
Practice Address - Phone:432-352-4443
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-06
Last Update Date:2016-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP125677261QP2300X, 261QU0200X, 261QX0100X
TXAP127457261QU0200X, 261QX0100X, 261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
No261QX0100XAmbulatory Health Care FacilitiesClinic/CenterOccupational Medicine