Rockdale Blackhawk, LLC

Primary specialty

Primary Care Clinic/CenterTaxonomy code 261QP2300X

Legal business name

ROCKDALE BLACKHAWK, LLC

Doing business as

Little River Medical Clinic - Hearne

Practice address

104 S Magnolia St
Hearne, TX 77859-2565

Phone

(979) 280-0022

Fax

(979) 280-0023

NPI assigned

Jul 31, 2007

Last updated

Feb 8, 2008By 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

Shana Davenport

Title

Insurance Credentialing Supervisor

Phone

(512) 446-4500

Specialties & licenses 1

Addresses

Other names 1

• Little River Medical Clinic - Hearne Doing business as

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

{
    "created_epoch": "1185840000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1202428800000",
    "number": "1982894408",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1010",
            "city": "ROCKDALE",
            "state": "TX",
            "postal_code": "765671010",
            "telephone_number": "512-446-4500",
            "fax_number": "512-446-2063"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "104 S MAGNOLIA ST",
            "city": "HEARNE",
            "state": "TX",
            "postal_code": "778592565",
            "telephone_number": "979-280-0022",
            "fax_number": "979-280-0023"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ROCKDALE BLACKHAWK, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-07-31",
        "last_updated": "2008-02-08",
        "status": "A",
        "authorized_official_last_name": "DAVENPORT",
        "authorized_official_first_name": "SHANA",
        "authorized_official_title_or_position": "INSURANCE CREDENTIALING SUPERVISOR",
        "authorized_official_telephone_number": "512-446-4500"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Little River Medical Clinic - Hearne",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Catherine O'Krafka, M.D.
• Christine Pinones, FNP
• Wendy Rapp, FNP
• Renal Treatment Centers Southeast LP (Hearne Dialysis Center)
• Ashley Shanise Richardson, MSN, APRN, FNP-C
• SLP Hearne LLC (Hearne Healthcare Center)
• St Joseph Regional Health Center (St Joseph-Hearne Family Medicine Clinic)
• Christin Turner, NP-C
• Lewis Frank Varvel, DDS
• VS Servant Hearts Home Care Service LLC

• Primary Care Clinic/Center in Hearne, TX
• Providers in Hearne, TX by specialty
• Primary Care Clinic/Center in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 8, 2008; 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.