Provider Demographics
NPI:1770804791
Name:MUENSTER FAMILY MEDICAL CLINIC, LLC
Entity type:Organization
Organization Name:MUENSTER FAMILY MEDICAL CLINIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTIONER
Authorized Official - Prefix:MRS
Authorized Official - First Name:AMY
Authorized Official - Middle Name:M
Authorized Official - Last Name:DANGELMAYR
Authorized Official - Suffix:
Authorized Official - Credentials:FNPC
Authorized Official - Phone:940-759-2502
Mailing Address - Street 1:PO BOX 647
Mailing Address - Street 2:134 S MESQUITE ST.
Mailing Address - City:MUENSTER
Mailing Address - State:TX
Mailing Address - Zip Code:76252-0647
Mailing Address - Country:US
Mailing Address - Phone:940-759-2502
Mailing Address - Fax:940-759-3608
Practice Address - Street 1:134 S MESQUITE ST
Practice Address - Street 2:
Practice Address - City:MUENSTER
Practice Address - State:TX
Practice Address - Zip Code:76252-2605
Practice Address - Country:US
Practice Address - Phone:940-759-2502
Practice Address - Fax:940-759-3608
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-14
Last Update Date:2020-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA01436363A00000X
TX651571363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX217000302Medicaid
TX217000301Medicaid
TX217000302Medicaid