Interstate Clinic LLC

NPI #1003448770 in Whitney, Texas

Provider Information

NPI Number: 1003448770
Entity Type: Organization
Organization Name: Interstate Clinic LLC
Primary Specialty: Clinic/Center - Primary Care
Enumeration Date: Feb 10, 2020
Last Updated: Aug 27, 2020

Practice Location

Address: 210 N BOSQUE ST
City: Whitney
State: Texas
ZIP Code: 76692-2416
Phone: (254) 221-4342

Authorized Official

Name: DR. RANDALL DALE HENDERSON, DO
Title: OWNER
Phone: (254) 707-0095

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Clinic/Center - Primary Care — Primary Care	261QP2300X	Primary

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