Provider Demographics
NPI:1104014463
Name:FAMILY PRACTICE ASSOCIATES
Entity Type:Organization
Organization Name:FAMILY PRACTICE ASSOCIATES
Other - Org Name:DAVID J. RANDELL, D. O., PA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:RANDELL
Authorized Official - Suffix:
Authorized Official - Credentials:D O,
Authorized Official - Phone:325-698-4221
Mailing Address - Street 1:35 WINDMILL CIR
Mailing Address - Street 2:
Mailing Address - City:ABILENE
Mailing Address - State:TX
Mailing Address - Zip Code:79606-5234
Mailing Address - Country:US
Mailing Address - Phone:325-698-4221
Mailing Address - Fax:
Practice Address - Street 1:35 WINDMILL CIR
Practice Address - Street 2:
Practice Address - City:ABILENE
Practice Address - State:TX
Practice Address - Zip Code:79606-5234
Practice Address - Country:US
Practice Address - Phone:325-698-4221
Practice Address - Fax:325-698-6951
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-11
Last Update Date:2007-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH5795302F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX133854306Medicaid
1932198611OtherINDIVIDUAL NPI
TX133854306Medicaid