Provider Demographics
NPI:1407195233
Name:FAMILY PRACTICE ASSOCIATES OF TAOS
Entity Type:Organization
Organization Name:FAMILY PRACTICE ASSOCIATES OF TAOS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHREIBER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:575-758-3005
Mailing Address - Street 1:630 PASEO DEL PUEBLO SUR STE 150
Mailing Address - Street 2:
Mailing Address - City:TAOS
Mailing Address - State:NM
Mailing Address - Zip Code:87571-7002
Mailing Address - Country:US
Mailing Address - Phone:575-758-3005
Mailing Address - Fax:575-758-7010
Practice Address - Street 1:630 PASEO DEL PUEBLO SUR STE 150
Practice Address - Street 2:
Practice Address - City:TAOS
Practice Address - State:NM
Practice Address - Zip Code:87571-7002
Practice Address - Country:US
Practice Address - Phone:575-758-3005
Practice Address - Fax:575-758-7010
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FAMILY PRACTICE ASSOCIATES OF TAOS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-02-14
Last Update Date:2013-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes293D00000XLaboratoriesPhysiological Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM46268Medicaid
NM46268Medicaid