Provider Demographics
NPI:1366497364
Name:FAMILY HEALTHCARE AFFILIATES PLLC
Entity Type:Organization
Organization Name:FAMILY HEALTHCARE AFFILIATES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KRYSTAL
Authorized Official - Middle Name:
Authorized Official - Last Name:URBAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:936-760-4454
Mailing Address - Street 1:800 RIVERWOOD CT
Mailing Address - Street 2:SUITE 105
Mailing Address - City:CONROE
Mailing Address - State:TX
Mailing Address - Zip Code:77304-2890
Mailing Address - Country:US
Mailing Address - Phone:936-760-4454
Mailing Address - Fax:936-760-4415
Practice Address - Street 1:800 RIVERWOOD CT
Practice Address - Street 2:SUITE 105
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77304-2890
Practice Address - Country:US
Practice Address - Phone:936-760-4454
Practice Address - Fax:936-760-4415
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-24
Last Update Date:2010-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX157678701Medicaid
TX0088HZOtherBCBS
TX157678701Medicaid