Provider Demographics
NPI:1023034667
Name:TOWNE CENTRE FAMILY HEALTHCARE CLINIC, PLLC
Entity Type:Organization
Organization Name:TOWNE CENTRE FAMILY HEALTHCARE CLINIC, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MRS.LEWIS
Authorized Official - Prefix:
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:LEWIS
Authorized Official - Suffix:
Authorized Official - Credentials:C-FNP
Authorized Official - Phone:409-755-2842
Mailing Address - Street 1:156 S MAIN ST
Mailing Address - Street 2:SUITE 120
Mailing Address - City:LUMBERTON
Mailing Address - State:TX
Mailing Address - Zip Code:77657-7881
Mailing Address - Country:US
Mailing Address - Phone:409-755-2842
Mailing Address - Fax:409-755-2855
Practice Address - Street 1:156 S MAIN ST STE 120
Practice Address - Street 2:
Practice Address - City:LUMBERTON
Practice Address - State:TX
Practice Address - Zip Code:77657-7882
Practice Address - Country:US
Practice Address - Phone:409-658-4315
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-15
Last Update Date:2008-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX595640363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXS63360Medicare UPIN
TX00Y415Medicare PIN