Provider Demographics
NPI:1225231574
Name:TEAGUE FAMILY SERVICES, INC.
Entity Type:Organization
Organization Name:TEAGUE FAMILY SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SHEILA
Authorized Official - Middle Name:Y
Authorized Official - Last Name:LONG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:254-772-3700
Mailing Address - Street 1:933 LAKE AIR DR
Mailing Address - Street 2:PO BOX 8727
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76710-4548
Mailing Address - Country:US
Mailing Address - Phone:254-772-3700
Mailing Address - Fax:254-772-3705
Practice Address - Street 1:933 LAKE AIR DR
Practice Address - Street 2:
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76710-4548
Practice Address - Country:US
Practice Address - Phone:254-772-3700
Practice Address - Fax:254-772-3705
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-06
Last Update Date:2008-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK1753207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty