Provider Demographics
NPI:1376673780
Name:ALSBURY FAMILY MEDICINE
Entity Type:Organization
Organization Name:ALSBURY FAMILY MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:NELDA
Authorized Official - Middle Name:NORINE
Authorized Official - Last Name:CUNNIFF
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:817-447-8080
Mailing Address - Street 1:780 NE ALSBURY BLVD STE B
Mailing Address - Street 2:
Mailing Address - City:BURLESON
Mailing Address - State:TX
Mailing Address - Zip Code:76028-2641
Mailing Address - Country:US
Mailing Address - Phone:817-447-8080
Mailing Address - Fax:817-447-7627
Practice Address - Street 1:780 NE ALSBURY BLVD STE B
Practice Address - Street 2:
Practice Address - City:BURLESON
Practice Address - State:TX
Practice Address - Zip Code:76028-2641
Practice Address - Country:US
Practice Address - Phone:817-447-8080
Practice Address - Fax:817-447-7627
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE2529204D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMMGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXA66076Medicare UPIN