Provider Demographics
NPI:1871124040
Name:ALSHINE HEALTHCARE CLINIC LLC
Entity type:Organization
Organization Name:ALSHINE HEALTHCARE CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:MR
Authorized Official - First Name:ALEX
Authorized Official - Middle Name:
Authorized Official - Last Name:GEORGE
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:630-779-7234
Mailing Address - Street 1:223 THE FALLS DR
Mailing Address - Street 2:
Mailing Address - City:SUNNYVALE
Mailing Address - State:TX
Mailing Address - Zip Code:75182-6205
Mailing Address - Country:US
Mailing Address - Phone:630-779-7234
Mailing Address - Fax:
Practice Address - Street 1:6330 BROADWAY BLVD STE C
Practice Address - Street 2:
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75043-5956
Practice Address - Country:US
Practice Address - Phone:972-441-4077
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-28
Last Update Date:2020-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care