Provider Demographics
NPI:1043233273
Name:FE FAMILY CLINIC, LLC
Entity Type:Organization
Organization Name:FE FAMILY CLINIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN ASSISTANT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:UNUIGBOJE
Authorized Official - Last Name:EROMOSELE
Authorized Official - Suffix:
Authorized Official - Credentials:P A,
Authorized Official - Phone:956-581-0401
Mailing Address - Street 1:PO BOX 3360
Mailing Address - Street 2:
Mailing Address - City:MISSION
Mailing Address - State:TX
Mailing Address - Zip Code:78573-0057
Mailing Address - Country:US
Mailing Address - Phone:956-581-0401
Mailing Address - Fax:956-581-0654
Practice Address - Street 1:8305 N. LA HOMA BLVD.
Practice Address - Street 2:SUITE # B
Practice Address - City:MISSION
Practice Address - State:TX
Practice Address - Zip Code:78574
Practice Address - Country:US
Practice Address - Phone:956-581-0401
Practice Address - Fax:956-581-0654
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-26
Last Update Date:2011-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX186061102Medicaid
TX186061101Medicaid
TXQ78135Medicare UPIN