Rockdale Blackhawk, LLC

NPI #1982894408 in Hearne, Texas

Provider Information

NPI Number: 1982894408
Entity Type: Organization
Organization Name: Rockdale Blackhawk, LLC
Primary Specialty: Clinic/Center - Primary Care
Enumeration Date: Jul 31, 2007
Last Updated: Feb 8, 2008

Practice Location

Address: 104 S MAGNOLIA ST
City: Hearne
State: Texas
ZIP Code: 77859-2565
Phone: (979) 280-0022

Authorized Official

Name: SHANA DAVENPORT
Title: INSURANCE CREDENTIALING SUPERVISOR
Phone: (512) 446-4500

Specialties & Taxonomy Codes

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

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