Provider Demographics
NPI:1073646030
Name:COLEMAN MEDICAL ASSOCIATES
Entity Type:Organization
Organization Name:COLEMAN MEDICAL ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LIZ
Authorized Official - Middle Name:
Authorized Official - Last Name:YOUNG
Authorized Official - Suffix:
Authorized Official - Credentials:LVN
Authorized Official - Phone:325-625-3533
Mailing Address - Street 1:PO BOX 312
Mailing Address - Street 2:
Mailing Address - City:COLEMAN
Mailing Address - State:TX
Mailing Address - Zip Code:76834-0312
Mailing Address - Country:US
Mailing Address - Phone:325-625-3533
Mailing Address - Fax:325-625-3477
Practice Address - Street 1:310 S PECOS ST
Practice Address - Street 2:2ND FLOOR
Practice Address - City:COLEMAN
Practice Address - State:TX
Practice Address - Zip Code:76834-4159
Practice Address - Country:US
Practice Address - Phone:325-625-3533
Practice Address - Fax:325-625-3477
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-13
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00241ZMedicare ID - Type UnspecifiedMEDICARE GROUP NUMBER