Provider Demographics
NPI:1417067083
Name:HEART OF TEXAS FAMILY MEDICINE, PA
Entity Type:Organization
Organization Name:HEART OF TEXAS FAMILY MEDICINE, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:C
Authorized Official - Last Name:HUBBARD
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:325-643-3300
Mailing Address - Street 1:PO BOX 249
Mailing Address - Street 2:
Mailing Address - City:BROWNWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:76804-0249
Mailing Address - Country:US
Mailing Address - Phone:325-643-3300
Mailing Address - Fax:325-643-3109
Practice Address - Street 1:109 S PARK DR
Practice Address - Street 2:
Practice Address - City:BROWNWOOD
Practice Address - State:TX
Practice Address - Zip Code:76801-5917
Practice Address - Country:US
Practice Address - Phone:325-643-3300
Practice Address - Fax:325-643-3109
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2009-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK5697207Q00000X
TXL4978207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX162000702Medicaid
TXDB4886OtherRR MEDICARE GROUP #
TX0078EROtherBCBS GROUP #
TX162000701Medicaid
TX162000701Medicaid