Provider Demographics
NPI:1134843758
Name:FAMICARE CLINIC
Entity type:Organization
Organization Name:FAMICARE CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:HANG
Authorized Official - Middle Name:
Authorized Official - Last Name:VU
Authorized Official - Suffix:
Authorized Official - Credentials:DNP
Authorized Official - Phone:972-804-4218
Mailing Address - Street 1:2445 CHESAPEAKE DR
Mailing Address - Street 2:
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75043-1497
Mailing Address - Country:US
Mailing Address - Phone:972-804-4218
Mailing Address - Fax:
Practice Address - Street 1:3465 W WALNUT ST STE 225
Practice Address - Street 2:
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75042-7140
Practice Address - Country:US
Practice Address - Phone:972-272-7816
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-27
Last Update Date:2022-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty