1396781761 NPI number — MAINLAND FAMILY PRACTICE, P.A.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1396781761 NPI number — MAINLAND FAMILY PRACTICE, P.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MAINLAND FAMILY PRACTICE, P.A.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1396781761
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/23/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
308 PINNACLE COVE CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LEAGUE CITY
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77573-0856
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
409-256-3639
Provider Business Mailing Address Fax Number:
281-334-5763

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6807 EMMETT F LOWRY EXPY
Provider Second Line Business Practice Location Address:
SUITE 300
Provider Business Practice Location Address City Name:
TEXAS CITY
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77591-2546
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
409-935-8400
Provider Business Practice Location Address Fax Number:
409-935-8404
Provider Enumeration Date:
06/22/2006

Additional Information

Authorized Official

Authorized Official Last Name:
LI
Authorized Official First Name:
FAN
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
409-935-8400

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  L0378 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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