Provider Demographics
NPI:1396868014
Name:AL FAIGIN DO AND N G FAIGIN DO LLP
Entity Type:Organization
Organization Name:AL FAIGIN DO AND N G FAIGIN DO LLP
Other - Org Name:WEDGEWOOD FAMILY HEALTH ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DR., OFFICE MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:G
Authorized Official - Last Name:FAIGIN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:817-294-0731
Mailing Address - Street 1:5703 WESTCREEK DR
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76133-3301
Mailing Address - Country:US
Mailing Address - Phone:817-294-0731
Mailing Address - Fax:817-294-8065
Practice Address - Street 1:5703 WESTCREEK DR
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76133-3301
Practice Address - Country:US
Practice Address - Phone:817-294-0731
Practice Address - Fax:817-294-8065
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-09
Last Update Date:2011-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207Q00000X
TXE4836207Q00000X
TXE4837207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX081042601Medicaid
TXA66298Medicare UPIN
TX8287K0Medicare ID - Type UnspecifiedDR. AL FAIGIN
TX8287K1Medicare ID - Type UnspecifiedDR. NANCY FAIGIN
TX081042601Medicaid