Provider Demographics
NPI:1962702431
Name:SHERMAN IMMEDIATE CARE CLINIC PLLC
Entity type:Organization
Organization Name:SHERMAN IMMEDIATE CARE CLINIC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:J
Authorized Official - Last Name:GAGE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:903-868-9565
Mailing Address - Street 1:913 COTTONWOOD DR
Mailing Address - Street 2:
Mailing Address - City:SHERMAN
Mailing Address - State:TX
Mailing Address - Zip Code:75090-2831
Mailing Address - Country:US
Mailing Address - Phone:903-868-9565
Mailing Address - Fax:
Practice Address - Street 1:913 COTTONWOOD DR
Practice Address - Street 2:
Practice Address - City:SHERMAN
Practice Address - State:TX
Practice Address - Zip Code:75090-2831
Practice Address - Country:US
Practice Address - Phone:903-868-9565
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-29
Last Update Date:2011-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXTXB128426Medicare PIN
TXTXB118343Medicare PIN
TXTXB118344Medicare PIN