Provider Demographics
NPI:1750482410
Name:JOHN F. KACZMAREK, M.D., P.A.
Entity Type:Organization
Organization Name:JOHN F. KACZMAREK, M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:F
Authorized Official - Last Name:KACZMAREK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:806-467-9400
Mailing Address - Street 1:3611 S SONCY RD
Mailing Address - Street 2:SUITE 5-B
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79119-6408
Mailing Address - Country:US
Mailing Address - Phone:806-467-9400
Mailing Address - Fax:
Practice Address - Street 1:3611 S SONCY RD
Practice Address - Street 2:SUITE 5-B
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79119-6480
Practice Address - Country:US
Practice Address - Phone:806-467-9400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-26
Last Update Date:2008-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE5804207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX122562504Medicaid
TXB23806Medicare UPIN
TXG31VMedicare ID - Type Unspecified
TX00Y894Medicare PIN