Provider Demographics
NPI:1417289380
Name:FAMILY PRACTICE OF TEXARKANA PLLC
Entity Type:Organization
Organization Name:FAMILY PRACTICE OF TEXARKANA PLLC
Other - Org Name:TEXARKANA FAMILY PRACTICE PA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CREDENTIALING MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:GIGI
Authorized Official - Middle Name:
Authorized Official - Last Name:CULBERSON
Authorized Official - Suffix:
Authorized Official - Credentials:CMC, CMIS
Authorized Official - Phone:903-793-0122
Mailing Address - Street 1:1408 COLLEGE DR
Mailing Address - Street 2:
Mailing Address - City:TEXARKANA
Mailing Address - State:TX
Mailing Address - Zip Code:75503-3534
Mailing Address - Country:US
Mailing Address - Phone:903-794-0515
Mailing Address - Fax:903-793-8000
Practice Address - Street 1:1408 COLLEGE DR
Practice Address - Street 2:
Practice Address - City:TEXARKANA
Practice Address - State:TX
Practice Address - Zip Code:75503-3534
Practice Address - Country:US
Practice Address - Phone:903-794-0515
Practice Address - Fax:903-793-8000
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-03
Last Update Date:2010-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty