Provider Demographics
NPI:1740450881
Name:ANGELINA FAMILY MEDICINE
Entity type:Organization
Organization Name:ANGELINA FAMILY MEDICINE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHYSICAN
Authorized Official - Prefix:MRS
Authorized Official - First Name:KARINA
Authorized Official - Middle Name:J
Authorized Official - Last Name:URQUIA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:936-699-4000
Mailing Address - Street 1:121 GASLIGHT MEDICAL PARKWAY
Mailing Address - Street 2:SUITE 101
Mailing Address - City:LUFKIN
Mailing Address - State:TX
Mailing Address - Zip Code:75904
Mailing Address - Country:US
Mailing Address - Phone:936-699-4000
Mailing Address - Fax:936-699-4001
Practice Address - Street 1:121 GASLIGHT MEDICAL PARKWAY
Practice Address - Street 2:SUITE 101
Practice Address - City:LUFKIN
Practice Address - State:TX
Practice Address - Zip Code:75904
Practice Address - Country:US
Practice Address - Phone:936-699-4000
Practice Address - Fax:936-699-4001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-05
Last Update Date:2008-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL5159207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXH71937Medicare UPIN