Provider Demographics
NPI:1447566211
Name:FAMILY DIAGNOSTIC MEDICAL CENTER, LLP
Entity Type:Organization
Organization Name:FAMILY DIAGNOSTIC MEDICAL CENTER, LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:GERARDO
Authorized Official - Middle Name:
Authorized Official - Last Name:CARBAJAL
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:254-580-1550
Mailing Address - Street 1:1314 N BRAZOS ST
Mailing Address - Street 2:
Mailing Address - City:WHITNEY
Mailing Address - State:TX
Mailing Address - Zip Code:76692-2010
Mailing Address - Country:US
Mailing Address - Phone:254-694-6997
Mailing Address - Fax:254-694-7007
Practice Address - Street 1:1314 N BRAZOS ST
Practice Address - Street 2:
Practice Address - City:WHITNEY
Practice Address - State:TX
Practice Address - Zip Code:76692-2010
Practice Address - Country:US
Practice Address - Phone:254-694-6997
Practice Address - Fax:254-694-7007
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-31
Last Update Date:2011-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty