Callahan County Health and Wellness Clinic PLLC

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

CALLAHAN COUNTY HEALTH AND WELLNESS CLINIC PLLC

Practice address

102 Archer St
Clyde, TX 79510-4225

Phone

(325) 893-1010

NPI assigned

May 20, 2022

Last updated

May 20, 2022By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Denise D Jones

Title

Administrator

Phone

(325) 695-4133

Specialties & licenses 1

Addresses

Other identifiers 1

Electronic endpoints 1

Interoperability endpoints

• Direct secure messaging: clydemedicalclinic@kareodirect.com

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

{
    "created_epoch": "1653004800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1653004800000",
    "number": "1619615663",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4400 BUFFALO GAP RD STE 2400C",
            "city": "ABILENE",
            "state": "TX",
            "postal_code": "796062723",
            "telephone_number": "132-569-5413"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "102 ARCHER ST",
            "city": "CLYDE",
            "state": "TX",
            "postal_code": "795104225",
            "telephone_number": "325-893-1010"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CALLAHAN COUNTY HEALTH AND WELLNESS CLINIC PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-05-20",
        "last_updated": "2022-05-20",
        "certification_date": "2022-05-20",
        "status": "A",
        "authorized_official_last_name": "JONES",
        "authorized_official_first_name": "DENISE",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "325-695-4133"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "APN LICENSE",
            "identifier": "AP113595",
            "state": "TX"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "clydemedicalclinic@kareodirect.com",
            "affiliation": "N",
            "address_1": "102 Archer St",
            "city": "Clyde",
            "state": "TX",
            "country_code": "US",
            "postal_code": "795104225",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• Family Medicine Physician in Clyde, TX
• Providers in Clyde, TX by specialty
• Family Medicine Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 20, 2022; 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.