Provider Demographics
NPI:1083475768
Name:FAMILYCARE PROVIDERS OF TEXAS PLLC
Entity Type:Organization
Organization Name:FAMILYCARE PROVIDERS OF TEXAS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:WENDELL
Authorized Official - Middle Name:L
Authorized Official - Last Name:SEMOUR
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:504-248-0891
Mailing Address - Street 1:11 RODEO BEND DR
Mailing Address - Street 2:
Mailing Address - City:MANVEL
Mailing Address - State:TX
Mailing Address - Zip Code:77578-1526
Mailing Address - Country:US
Mailing Address - Phone:337-290-1304
Mailing Address - Fax:
Practice Address - Street 1:11 RODEO BEND DR
Practice Address - Street 2:
Practice Address - City:MANVEL
Practice Address - State:TX
Practice Address - Zip Code:77578-1526
Practice Address - Country:US
Practice Address - Phone:337-290-1304
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-19
Last Update Date:2024-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty