Provider Demographics
NPI:1245993385
Name:PORT NECHES FAMILY MEDICINE
Entity type:Organization
Organization Name:PORT NECHES FAMILY MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ENP/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:YANCEY
Authorized Official - Middle Name:R
Authorized Official - Last Name:FOSTER
Authorized Official - Suffix:JR
Authorized Official - Credentials:ENP
Authorized Official - Phone:409-344-4010
Mailing Address - Street 1:2246 NALL ST
Mailing Address - Street 2:
Mailing Address - City:PORT NECHES
Mailing Address - State:TX
Mailing Address - Zip Code:77651
Mailing Address - Country:US
Mailing Address - Phone:409-540-0971
Mailing Address - Fax:
Practice Address - Street 1:2246 NALL ST
Practice Address - Street 2:
Practice Address - City:PORT NECHES
Practice Address - State:TX
Practice Address - Zip Code:77651
Practice Address - Country:US
Practice Address - Phone:409-344-4010
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-15
Last Update Date:2022-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty