Provider Demographics
NPI:1750474292
Name:Y2K MEDICAL PA
Entity Type:Organization
Organization Name:Y2K MEDICAL PA
Other - Org Name:FEAVER FAMILY PRACTICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICAN OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:FEAVER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:979-285-2100
Mailing Address - Street 1:201 THAT WAY
Mailing Address - Street 2:
Mailing Address - City:LAKE JACKSON
Mailing Address - State:TX
Mailing Address - Zip Code:77566
Mailing Address - Country:US
Mailing Address - Phone:979-285-2100
Mailing Address - Fax:979-297-0200
Practice Address - Street 1:201 THAT WAY
Practice Address - Street 2:
Practice Address - City:LAKE JACKSON
Practice Address - State:TX
Practice Address - Zip Code:77566
Practice Address - Country:US
Practice Address - Phone:979-285-2100
Practice Address - Fax:979-297-0200
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2012-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ7953207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
G17043Medicare UPIN
00381TMedicare ID - Type Unspecified