NPIMap

Organization Active NPI

Slaton Family Medical, PLLC.

  • Rural Health Clinic/Center
  • Slaton, TX
National Provider Identifier
1750573416
Registry record updated Aug 7, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
SLATON FAMILY MEDICAL, PLLC.
Practice address
235 W Garza St
Suite B
Slaton, TX 79364-4127
Phone
(806) 828-1600
Fax
(806) 828-1610
NPI assigned
Aug 15, 2007
Last updated
Aug 7, 2013By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 7, 2013

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

Authorized official

Name
Mr. Al Bendeck, PA-C
Title
President
Phone
(806) 828-1600

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X NU Primary

Addresses

Primary practice location

235 W Garza St
Suite B
Slaton, TX 79364-4127

Mailing address

PO Box 54136
Lubbock, TX 79453-4136
Phone (806) 771-1386

Other identifiers 1

IdentifierTypeStateIssuer
210889601MedicaidTX

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20070926001193 TX Part A Provider - Rural Health Clinic 3678668340 Practice locations: Slaton, TX

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1750573416. Details of each certification follow.

Rural health clinic certification: CCN 673911

Legal name
SLATON FAMILY MEDICAL, PLLC.
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Feb 17, 2010
Last certification
Dec 8, 2015
Ownership / control type
1A
Organization structure
LLCProprietary
Incorporated
Jun 22, 2003 in TX
Enrollment address
163 S 9TH St
Slaton, TX 79364-4121

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
45D1073332Slaton Family Medical163 S 9TH Street, Slaton, TX 79364Certificate of waiverJun 4, 2028

National Provider Directory

National Provider Directory

Locations

163 S 9th St
Slaton, TX 79364
Phone (806) 828-1600

235 W Garza St
#B
Slaton, TX 79364
Phone (806) 777-3230

Ownership & related parties

All disclosed owners & managing parties 1

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Ashley Nicole White Individual 5% Or Greater Direct Ownership Interest Nov 1, 2024 100%
W-2 Managing Employee Nov 1, 2024

Owners & managing parties with NPI records 1

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Practitioners & affiliated clinicians

Practitioners 7

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1187136000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1375833600000",
    "number": "1750573416",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 54136",
            "city": "LUBBOCK",
            "state": "TX",
            "postal_code": "794534136",
            "telephone_number": "806-771-1386",
            "fax_number": "806-771-1388"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "235 W GARZA ST",
            "address_2": "SUITE B",
            "city": "SLATON",
            "state": "TX",
            "postal_code": "793644127",
            "telephone_number": "806-828-1600",
            "fax_number": "806-828-1610"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SLATON FAMILY MEDICAL, PLLC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-08-15",
        "last_updated": "2013-08-07",
        "status": "A",
        "authorized_official_last_name": "BENDECK",
        "authorized_official_first_name": "AL",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "806-828-1600",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "PA-C"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "210889601",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Slaton, TX

Sources for this page

Verify at the official NPI Registry.