Provider Demographics
NPI:1689689556
Name:CONTEMPORARY FAMILY MEDICINE TRUST
Entity Type:Organization
Organization Name:CONTEMPORARY FAMILY MEDICINE TRUST
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:N
Authorized Official - Last Name:STOKES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:281-592-2888
Mailing Address - Street 1:200 E BOOTHE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:CLEVELAND
Mailing Address - State:TX
Mailing Address - Zip Code:77327-4063
Mailing Address - Country:US
Mailing Address - Phone:281-592-2888
Mailing Address - Fax:281-361-6322
Practice Address - Street 1:200 EAST BOOTHE
Practice Address - Street 2:# 100
Practice Address - City:CLEVELAND
Practice Address - State:TX
Practice Address - Zip Code:77327-4063
Practice Address - Country:US
Practice Address - Phone:281-592-2888
Practice Address - Fax:281-361-6322
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-29
Last Update Date:2010-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
4500921162291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
CL0530Medicare PIN