Provider Demographics
NPI:1417246281
Name:FAMILY HEALTH CENTER OF BASTROP PLLC
Entity Type:Organization
Organization Name:FAMILY HEALTH CENTER OF BASTROP PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JOHNNY
Authorized Official - Middle Name:
Authorized Official - Last Name:BURNS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-304-0300
Mailing Address - Street 1:3101 HWY 71 E
Mailing Address - Street 2:101
Mailing Address - City:BASTROP
Mailing Address - State:TX
Mailing Address - Zip Code:78602-5159
Mailing Address - Country:US
Mailing Address - Phone:512-304-0300
Mailing Address - Fax:512-304-0341
Practice Address - Street 1:3101 HWY 71 E
Practice Address - Street 2:101
Practice Address - City:BASTROP
Practice Address - State:TX
Practice Address - Zip Code:78602-5159
Practice Address - Country:US
Practice Address - Phone:512-304-0300
Practice Address - Fax:512-304-0341
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-01
Last Update Date:2015-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty