Provider Demographics
NPI:1447445804
Name:LIVE OAK COUNTY
Entity type:Organization
Organization Name:LIVE OAK COUNTY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE
Authorized Official - Prefix:
Authorized Official - First Name:IDA
Authorized Official - Middle Name:
Authorized Official - Last Name:FLORES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:361-449-8019
Mailing Address - Street 1:PO BOX 699
Mailing Address - Street 2:
Mailing Address - City:GEORGE WEST
Mailing Address - State:TX
Mailing Address - Zip Code:78022-0699
Mailing Address - Country:US
Mailing Address - Phone:361-449-2733
Mailing Address - Fax:361-449-3626
Practice Address - Street 1:102 N HARBORTH AVE
Practice Address - Street 2:
Practice Address - City:THREE RIVERS
Practice Address - State:TX
Practice Address - Zip Code:78071
Practice Address - Country:US
Practice Address - Phone:361-786-3820
Practice Address - Fax:361-786-3820
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-10
Last Update Date:2023-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX001001677251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXPH0050Medicare PIN