Provider Demographics
NPI:1427367002
Name:ST. ELIZABETH FAMILY CARE, LLC
Entity Type:Organization
Organization Name:ST. ELIZABETH FAMILY CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:SPANGLER
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:281-218-7200
Mailing Address - Street 1:PO BOX 1619
Mailing Address - Street 2:
Mailing Address - City:DICKINSON
Mailing Address - State:TX
Mailing Address - Zip Code:77539-1619
Mailing Address - Country:US
Mailing Address - Phone:713-482-4535
Mailing Address - Fax:713-482-4560
Practice Address - Street 1:676 FM 517 RD W
Practice Address - Street 2:
Practice Address - City:DICKINSON
Practice Address - State:TX
Practice Address - Zip Code:77539-3904
Practice Address - Country:US
Practice Address - Phone:713-482-4535
Practice Address - Fax:713-482-4560
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-30
Last Update Date:2011-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty