Provider Demographics
NPI:1003932492
Name:FAMILY PRACTICE HOUSE CALLS PA
Entity Type:Organization
Organization Name:FAMILY PRACTICE HOUSE CALLS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOE
Authorized Official - Middle Name:B
Authorized Official - Last Name:VENTIMIGLIA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:214-865-7331
Mailing Address - Street 1:11882 GREENVILLE AVE
Mailing Address - Street 2:SUITE B100
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75243-0586
Mailing Address - Country:US
Mailing Address - Phone:214-865-7331
Mailing Address - Fax:855-237-5132
Practice Address - Street 1:11882 GREENVILLE AVE
Practice Address - Street 2:SUITE B100
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75243-0586
Practice Address - Country:US
Practice Address - Phone:214-865-7331
Practice Address - Fax:855-237-5132
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-21
Last Update Date:2013-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK0231207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX179513001Medicaid
TX00436ZMedicare ID - Type UnspecifiedGROUP PRACTICE PROVIDER #