Provider Demographics
NPI:1992052039
Name:VERNON CLINIC PLLC
Entity type:Organization
Organization Name:VERNON CLINIC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:ADANNA
Authorized Official - Middle Name:JULIET
Authorized Official - Last Name:AMECHI-OBIGWE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:940-552-2530
Mailing Address - Street 1:1015 HILLCREST DR STE A
Mailing Address - Street 2:
Mailing Address - City:VERNON
Mailing Address - State:TX
Mailing Address - Zip Code:76384-3165
Mailing Address - Country:US
Mailing Address - Phone:940-552-2530
Mailing Address - Fax:940-552-2539
Practice Address - Street 1:1015 HILLCREST DR
Practice Address - Street 2:
Practice Address - City:VERNON
Practice Address - State:TX
Practice Address - Zip Code:76384-3100
Practice Address - Country:US
Practice Address - Phone:940-552-2530
Practice Address - Fax:940-552-2539
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-08
Last Update Date:2020-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty