1568617512 NPI number — ABILENE FAMILY HEALTH CARE, P.A.

Table of content: (NPI 1568617512)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1568617512 NPI number — ABILENE FAMILY HEALTH CARE, P.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ABILENE FAMILY HEALTH CARE, 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:
1568617512
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/27/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1181 LYTLE WAY
Provider Second Line Business Mailing Address:
SUITE F
Provider Business Mailing Address City Name:
ABILENE
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
79602-4299
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
325-701-4818
Provider Business Mailing Address Fax Number:
325-701-4429

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1933 PINE ST
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
ABILENE
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
79601-2431
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
325-675-0338
Provider Business Practice Location Address Fax Number:
325-672-5049
Provider Enumeration Date:
11/18/2008

Additional Information

Authorized Official

Authorized Official Last Name:
MCKNIGHT
Authorized Official First Name:
MAXEY
Authorized Official Middle Name:
DELL
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
325-675-0338

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  F6935 , 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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