Provider Demographics
NPI:1639735335
Name:ADVENTHEALTH FAMILY MEDICINE RURAL HEALTH CLINICS, INC.
Entity Type:Organization
Organization Name:ADVENTHEALTH FAMILY MEDICINE RURAL HEALTH CLINICS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT PHYSICIAN SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:
Authorized Official - Last Name:JASINSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-568-4556
Mailing Address - Street 1:PO BOX 6278
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76115-0278
Mailing Address - Country:US
Mailing Address - Phone:817-568-4556
Mailing Address - Fax:817-568-5474
Practice Address - Street 1:187 PR 4060
Practice Address - Street 2:
Practice Address - City:LAMPASAS
Practice Address - State:TX
Practice Address - Zip Code:76550-4071
Practice Address - Country:US
Practice Address - Phone:512-556-3621
Practice Address - Fax:512-556-6594
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-17
Last Update Date:2020-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty