Provider Demographics
NPI:1073727368
Name:TIMARRON FAMILY MEDICINE PA
Entity Type:Organization
Organization Name:TIMARRON FAMILY MEDICINE PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:RENEE
Authorized Official - Last Name:BARTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-481-4739
Mailing Address - Street 1:200 PECAN CRK
Mailing Address - Street 2:
Mailing Address - City:SOUTHLAKE
Mailing Address - State:TX
Mailing Address - Zip Code:76092-6371
Mailing Address - Country:US
Mailing Address - Phone:817-481-4739
Mailing Address - Fax:817-481-5198
Practice Address - Street 1:200 PECAN CRK
Practice Address - Street 2:
Practice Address - City:SOUTHLAKE
Practice Address - State:TX
Practice Address - Zip Code:76092-6371
Practice Address - Country:US
Practice Address - Phone:817-481-4739
Practice Address - Fax:817-481-5198
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-09
Last Update Date:2007-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ4265207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00124NMedicare ID - Type UnspecifiedGROUP ID