Provider Demographics
NPI:1396176608
Name:DR. FARRELL FAMILY PRACTICE
Entity type:Organization
Organization Name:DR. FARRELL FAMILY PRACTICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:FARRELL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:979-257-8193
Mailing Address - Street 1:1007 PHILLIPS CIR
Mailing Address - Street 2:
Mailing Address - City:EAST BERNARD
Mailing Address - State:TX
Mailing Address - Zip Code:77435-8450
Mailing Address - Country:US
Mailing Address - Phone:979-257-8193
Mailing Address - Fax:979-335-4185
Practice Address - Street 1:1007 PHILLIPS CIR
Practice Address - Street 2:
Practice Address - City:EAST BERNARD
Practice Address - State:TX
Practice Address - Zip Code:77435-8450
Practice Address - Country:US
Practice Address - Phone:979-257-8193
Practice Address - Fax:979-335-4185
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-12
Last Update Date:2013-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF-1539261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care