Provider Demographics
NPI:1841868965
Name:FAMILY MEDICINE CLINIC
Entity type:Organization
Organization Name:FAMILY MEDICINE CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:TARA
Authorized Official - Middle Name:
Authorized Official - Last Name:BOHNERT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-633-2585
Mailing Address - Street 1:8738 N LAMAR BLVD
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78753-5410
Mailing Address - Country:US
Mailing Address - Phone:512-834-2035
Mailing Address - Fax:
Practice Address - Street 1:8738 N LAMAR BLVD
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78753-5410
Practice Address - Country:US
Practice Address - Phone:512-834-2035
Practice Address - Fax:512-834-9661
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-15
Last Update Date:2025-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty