Provider Demographics
NPI:1013359892
Name:FAMILY MEDICINE AND RESEARCH CENTER PA
Entity Type:Organization
Organization Name:FAMILY MEDICINE AND RESEARCH CENTER PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:
Authorized Official - Last Name:ATUDONYANG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:469-952-8052
Mailing Address - Street 1:1625 N STORY RD STE 148
Mailing Address - Street 2:FAMILY MEDICINE AND RESEARCH CENTER
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75061-1953
Mailing Address - Country:US
Mailing Address - Phone:469-952-8052
Mailing Address - Fax:
Practice Address - Street 1:1625 N STORY RD STE 148
Practice Address - Street 2:FAMILY MEDICINE AND RESEARCH CENTER
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75061-1953
Practice Address - Country:US
Practice Address - Phone:469-952-8052
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-23
Last Update Date:2013-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center