Provider Demographics
NPI:1881492502
Name:BLUES FAMILY PRACTICE
Entity type:Organization
Organization Name:BLUES FAMILY PRACTICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FAMILY PRACTITIONER
Authorized Official - Prefix:MS
Authorized Official - First Name:SOLANGE
Authorized Official - Middle Name:
Authorized Official - Last Name:MFORBI
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:940-220-8302
Mailing Address - Street 1:833 CHAPLIN DR
Mailing Address - Street 2:
Mailing Address - City:JUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:76247-2284
Mailing Address - Country:US
Mailing Address - Phone:405-885-4600
Mailing Address - Fax:
Practice Address - Street 1:2701 W OAK ST STE 100
Practice Address - Street 2:
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76201-2328
Practice Address - Country:US
Practice Address - Phone:940-220-8302
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-03-06
Last Update Date:2025-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty