Provider Demographics
NPI:1992168900
Name:CLINE FAMILY PRACTICE
Entity type:Organization
Organization Name:CLINE FAMILY PRACTICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:A
Authorized Official - Last Name:CLINE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:936-559-8770
Mailing Address - Street 1:4604 NE STALLINGS DR
Mailing Address - Street 2:
Mailing Address - City:NACOGDOCHES
Mailing Address - State:TX
Mailing Address - Zip Code:75965-1608
Mailing Address - Country:US
Mailing Address - Phone:936-559-8770
Mailing Address - Fax:936-559-8773
Practice Address - Street 1:4604 NE STALLINGS DR
Practice Address - Street 2:
Practice Address - City:NACOGDOCHES
Practice Address - State:TX
Practice Address - Zip Code:75965-1608
Practice Address - Country:US
Practice Address - Phone:936-559-8770
Practice Address - Fax:936-559-8773
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-29
Last Update Date:2016-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX135176907Medicaid
TX135176908Medicaid
TX0026BSOtherMEDICARE PTAN
TX135176908Medicaid