Provider Demographics
NPI:1174837181
Name:FAMILY HEALTH SPA LLC
Entity Type:Organization
Organization Name:FAMILY HEALTH SPA LLC
Other - Org Name:FAMILY HEALTH SPA & MINOR EMERGENCY CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:VANBURKLEO
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:361-815-7818
Mailing Address - Street 1:10102 S PADRE ISLAND DR
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78418-4410
Mailing Address - Country:US
Mailing Address - Phone:361-937-3303
Mailing Address - Fax:361-937-3305
Practice Address - Street 1:10102 S PADRE ISLAND DR
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78418-4410
Practice Address - Country:US
Practice Address - Phone:361-937-3303
Practice Address - Fax:361-937-3305
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-02
Last Update Date:2011-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty