Provider Demographics
NPI:1568617512
Name:ABILENE FAMILY HEALTH CARE, P.A.
Entity Type:Organization
Organization Name:ABILENE FAMILY HEALTH CARE, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MAXEY
Authorized Official - Middle Name:DELL
Authorized Official - Last Name:MCKNIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:325-675-0338
Mailing Address - Street 1:1181 LYTLE WAY
Mailing Address - Street 2:SUITE F
Mailing Address - City:ABILENE
Mailing Address - State:TX
Mailing Address - Zip Code:79602-4299
Mailing Address - Country:US
Mailing Address - Phone:325-701-4818
Mailing Address - Fax:325-701-4429
Practice Address - Street 1:1933 PINE ST
Practice Address - Street 2:SUITE B
Practice Address - City:ABILENE
Practice Address - State:TX
Practice Address - Zip Code:79601-2431
Practice Address - Country:US
Practice Address - Phone:325-675-0338
Practice Address - Fax:325-672-5049
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-18
Last Update Date:2009-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF6935207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0A0319Medicare PIN