Provider Demographics
NPI:1821487927
Name:WATERLOO FAMILY PRACTICE, PLLC
Entity Type:Organization
Organization Name:WATERLOO FAMILY PRACTICE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:FRANCES
Authorized Official - Middle Name:
Authorized Official - Last Name:KILLEBREW
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:512-828-6959
Mailing Address - Street 1:5410 GREAT DIVIDE DR
Mailing Address - Street 2:
Mailing Address - City:BEE CAVE
Mailing Address - State:TX
Mailing Address - Zip Code:78738-6119
Mailing Address - Country:US
Mailing Address - Phone:512-828-6959
Mailing Address - Fax:
Practice Address - Street 1:2765 BEE CAVES RD STE 201
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78746-5640
Practice Address - Country:US
Practice Address - Phone:512-328-2752
Practice Address - Fax:512-697-9328
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-13
Last Update Date:2015-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty