Provider Demographics
NPI:1326220203
Name:FAMILY MEDICINE OF ROCKPORT
Entity Type:Organization
Organization Name:FAMILY MEDICINE OF ROCKPORT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RACHEL
Authorized Official - Middle Name:D
Authorized Official - Last Name:MAYBERRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:361-790-5233
Mailing Address - Street 1:PO BOX 1865
Mailing Address - Street 2:
Mailing Address - City:ROCKPORT
Mailing Address - State:TX
Mailing Address - Zip Code:78381-1865
Mailing Address - Country:US
Mailing Address - Phone:361-790-5233
Mailing Address - Fax:361-790-5241
Practice Address - Street 1:2871 HIGHWAY 35 N
Practice Address - Street 2:
Practice Address - City:ROCKPORT
Practice Address - State:TX
Practice Address - Zip Code:78382-5712
Practice Address - Country:US
Practice Address - Phone:361-790-5233
Practice Address - Fax:361-790-5241
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-03
Last Update Date:2007-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service