Provider Demographics
NPI:1447711007
Name:DMCTX2, PLLC
Entity type:Organization
Organization Name:DMCTX2, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:DELLA
Authorized Official - Middle Name:VICTORIA
Authorized Official - Last Name:BUMSTEAD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:409-429-8457
Mailing Address - Street 1:410 GASLIGHT BLVD
Mailing Address - Street 2:
Mailing Address - City:LUFKIN
Mailing Address - State:TX
Mailing Address - Zip Code:75904-3123
Mailing Address - Country:US
Mailing Address - Phone:936-630-8813
Mailing Address - Fax:
Practice Address - Street 1:410 GASLIGHT BLVD
Practice Address - Street 2:
Practice Address - City:LUFKIN
Practice Address - State:TX
Practice Address - Zip Code:75904-3123
Practice Address - Country:US
Practice Address - Phone:936-635-1127
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-27
Last Update Date:2021-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-SpecialtyGroup - Single Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care