ITASCA HEALING MEDICAL PRACTICE NPI 1023867546

NPI Information

  • NPI: 1023867546
  • Provider Name: ITASCA HEALING MEDICAL PRACTICE
  • Classification: Family Medicine - 207Q00000X
  • Entity Type: Organization
  • CLIA Number: 45D2306063
  • Address: 223 KING ST
    NACOGDOCHES, TX
    ZIP 75961
  • Phone: (936) 622-0552

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NPI Details

ITASCA HEALING MEDICAL PRACTICE is a family medicine in Nacogdoches, TX. The provider is family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. ITASCA HEALING MEDICAL PRACTICE NPI is 1023867546. The provider is registered as an organization entity type and is a multi-specialty group.

The provider's business location address is:

223 KING ST
NACOGDOCHES, TX
ZIP 75961-421
Phone: (936) 622-0552
Fax: (936) 622-0554

The provider's authorized official is Suzanna Itasca Fuller .
The authorized official title is Owner and has the following contact phone number (936) 250-2062.

The CLIA number assigned to this NPI record is 45D2306063 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 5/16/2024 and was last updated on 10/2/2024.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1207Q00000XFamily MedicineYes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 3/30/2025

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