Provider Demographics
NPI:1417231929
Name:FERRIS FAMILY MEDICINE, PA
Entity Type:Organization
Organization Name:FERRIS FAMILY MEDICINE, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:BRIDGET
Authorized Official - Middle Name:E
Authorized Official - Last Name:MEGNA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-842-3334
Mailing Address - Street 1:207 W 5TH ST
Mailing Address - Street 2:
Mailing Address - City:FERRIS
Mailing Address - State:TX
Mailing Address - Zip Code:75125-2021
Mailing Address - Country:US
Mailing Address - Phone:972-842-3016
Mailing Address - Fax:972-842-3940
Practice Address - Street 1:207 W 5TH ST
Practice Address - Street 2:
Practice Address - City:FERRIS
Practice Address - State:TX
Practice Address - Zip Code:75125-2021
Practice Address - Country:US
Practice Address - Phone:972-842-3016
Practice Address - Fax:972-842-3940
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-03
Last Update Date:2011-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty