Provider Demographics
NPI:1871248906
Name:BALD EAGLE FAMILY MEDICINE
Entity Type:Organization
Organization Name:BALD EAGLE FAMILY MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:TONY
Authorized Official - Middle Name:
Authorized Official - Last Name:HEDGES
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:682-205-1079
Mailing Address - Street 1:PO BOX 355
Mailing Address - Street 2:
Mailing Address - City:GRANBURY
Mailing Address - State:TX
Mailing Address - Zip Code:76048-0355
Mailing Address - Country:US
Mailing Address - Phone:682-205-1079
Mailing Address - Fax:682-214-3222
Practice Address - Street 1:2214 E US HIGHWAY 377 STE BANDC
Practice Address - Street 2:
Practice Address - City:GRANBURY
Practice Address - State:TX
Practice Address - Zip Code:76049-6010
Practice Address - Country:US
Practice Address - Phone:682-205-1079
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-17
Last Update Date:2023-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty