Provider Demographics
NPI:1710066519
Name:DEER PARK FAMILY CLINIC, P.A.
Entity Type:Organization
Organization Name:DEER PARK FAMILY CLINIC, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:AMY
Authorized Official - Middle Name:L
Authorized Official - Last Name:STRAHAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-479-5941
Mailing Address - Street 1:2910 CENTER ST
Mailing Address - Street 2:
Mailing Address - City:DEER PARK
Mailing Address - State:TX
Mailing Address - Zip Code:77536-4943
Mailing Address - Country:US
Mailing Address - Phone:281-479-5941
Mailing Address - Fax:281-542-1861
Practice Address - Street 1:2910 CENTER ST
Practice Address - Street 2:
Practice Address - City:DEER PARK
Practice Address - State:TX
Practice Address - Zip Code:77536
Practice Address - Country:US
Practice Address - Phone:281-479-5941
Practice Address - Fax:281-542-1861
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-03
Last Update Date:2010-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX079578301Medicaid
TX00020HMedicare ID - Type UnspecifiedMEDICARE GROUP NUMBER