Provider Demographics
NPI:1245468164
Name:LIFSHEN FAMILY CLINIC PA
Entity type:Organization
Organization Name:LIFSHEN FAMILY CLINIC PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:WISE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-279-4402
Mailing Address - Street 1:912 S CAPITAL OF TEXAS HWY
Mailing Address - Street 2:STE 100
Mailing Address - City:WEST LAKE HILLS
Mailing Address - State:TX
Mailing Address - Zip Code:78746-5264
Mailing Address - Country:US
Mailing Address - Phone:512-306-8360
Mailing Address - Fax:512-306-8176
Practice Address - Street 1:912 S CAPITAL OF TEXAS HWY
Practice Address - Street 2:STE 100
Practice Address - City:WEST LAKE HILLS
Practice Address - State:TX
Practice Address - Zip Code:78746-5264
Practice Address - Country:US
Practice Address - Phone:512-306-8360
Practice Address - Fax:512-306-8176
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-30
Last Update Date:2009-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH4492174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty