Park Clinic PA

Primary specialty

Clinic/CenterTaxonomy code 261Q00000X

Legal business name

PARK CLINIC PA

Practice address

310 W Alameda
Iowa Park, TX 76367-1600

Phone

(940) 592-4141

Fax

(940) 592-4842

NPI assigned

Sep 11, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Fausto Avila, MD

Title

Sect Treasure

Phone

(940) 592-4141

Specialties & licenses 1

Addresses

Other identifiers 1

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1157932800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1538263702",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "P O BOX 639",
            "city": "IOWA PARK",
            "state": "TX",
            "postal_code": "763671639",
            "telephone_number": "940-592-4141",
            "fax_number": "940-592-4842"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "310 W ALAMEDA",
            "city": "IOWA PARK",
            "state": "TX",
            "postal_code": "763671600",
            "telephone_number": "940-592-4141",
            "fax_number": "940-592-4842"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PARK CLINIC PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-11",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "AVILA",
        "authorized_official_first_name": "FAUSTO",
        "authorized_official_title_or_position": "SECT TREASURE",
        "authorized_official_telephone_number": "940-592-4141",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1115859",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Troy Glen Murray, D.C.
• Murray'S Apollo Chiropractic
• Nexion Health at Iowa Park, Inc.
• Pablo Cortez Teveni, MD PA
• Laura Maye Palmer, CPHT
• Jacie Makaye Payton
• David Edmund Potter, D.O.
• Kelley Jean Pruitt, CNS, FNP
• Lauren Michelle Rains, D.C.
• Robin Denise Roberts, RN

• Clinic/Center in Iowa Park, TX
• Providers in Iowa Park, TX by specialty
• Clinic/Center in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.