Provider Demographics
NPI:1003018490
Name:PHYSICIANS FAMILY PRACTICE ASSOCIATES
Entity Type:Organization
Organization Name:PHYSICIANS FAMILY PRACTICE ASSOCIATES
Other - Org Name:SOUTHWEST MEDICAL ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DR
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:RICHARD
Authorized Official - Last Name:BOHNSACK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:817-346-4000
Mailing Address - Street 1:5701 BRYANT IRVIN RD
Mailing Address - Street 2:SUITE 203
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76132-4029
Mailing Address - Country:US
Mailing Address - Phone:817-346-4000
Mailing Address - Fax:817-263-9398
Practice Address - Street 1:5701 BRYANT IRVIN RD
Practice Address - Street 2:SUITE 203
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76132-4029
Practice Address - Country:US
Practice Address - Phone:817-346-4000
Practice Address - Fax:817-263-9398
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-05
Last Update Date:2009-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF1396207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00858KMedicare ID - Type UnspecifiedGROUP
TXB21355Medicare UPIN
TX83534NMedicare ID - Type Unspecified