Provider Demographics
NPI:1881619864
Name:FAMILY PRACTICE ASSOCIATES OF TAOS
Entity type:Organization
Organization Name:FAMILY PRACTICE ASSOCIATES OF TAOS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:HUGH
Authorized Official - Last Name:SCHREIBER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:505-758-3005
Mailing Address - Street 1:630 PASEO DEL PUEBLO SUR
Mailing Address - Street 2:SUITE 150
Mailing Address - City:TAOS
Mailing Address - State:NM
Mailing Address - Zip Code:87571-6070
Mailing Address - Country:US
Mailing Address - Phone:505-758-3005
Mailing Address - Fax:505-758-7010
Practice Address - Street 1:630 PASEO DEL PUEBLO SUR
Practice Address - Street 2:SUITE 150
Practice Address - City:TAOS
Practice Address - State:NM
Practice Address - Zip Code:87571-6070
Practice Address - Country:US
Practice Address - Phone:505-758-3005
Practice Address - Fax:505-758-7010
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-12
Last Update Date:2013-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0034207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM46268Medicaid
CS0629OtherRAILROAD MEDICARE
NM2372985Medicare PIN