Provider Demographics
NPI:1396011706
Name:DR. VICKI SEIDMEYER, FAMILY PRACTICE, A PROFESSIONAL ASSOCIATION
Entity Type:Organization
Organization Name:DR. VICKI SEIDMEYER, FAMILY PRACTICE, A PROFESSIONAL ASSOCIATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:VICKI
Authorized Official - Middle Name:L
Authorized Official - Last Name:SEIDMEYER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:972-542-1180
Mailing Address - Street 1:2760 VIRGINIA PKWY.
Mailing Address - Street 2:SUITE 100
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75071-4964
Mailing Address - Country:US
Mailing Address - Phone:972-542-1180
Mailing Address - Fax:
Practice Address - Street 1:2760 VIRGINIA PKWY.
Practice Address - Street 2:SUITE 100
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75071-4964
Practice Address - Country:US
Practice Address - Phone:972-542-1180
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-29
Last Update Date:2012-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK0376207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX121324103Medicaid
TXG34016Medicare UPIN
TX121324103Medicaid