Provider Demographics
NPI:1912134768
Name:SPANGLER MEDICAL ENTERPRISES PA
Entity Type:Organization
Organization Name:SPANGLER MEDICAL ENTERPRISES PA
Other - Org Name:BAY AREA HOUSE CALLS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:W
Authorized Official - Last Name:SPANGLER
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:281-218-7200
Mailing Address - Street 1:646 FM 517 RD W
Mailing Address - Street 2:
Mailing Address - City:DICKINSON
Mailing Address - State:TX
Mailing Address - Zip Code:77539-3904
Mailing Address - Country:US
Mailing Address - Phone:281-218-7200
Mailing Address - Fax:281-218-7203
Practice Address - Street 1:646 FM 517 RD W
Practice Address - Street 2:
Practice Address - City:DICKINSON
Practice Address - State:TX
Practice Address - Zip Code:77539-3904
Practice Address - Country:US
Practice Address - Phone:281-218-7200
Practice Address - Fax:281-218-7203
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-19
Last Update Date:2015-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL4728207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX158438001Medicaid
TX610104Medicare PIN
TX158438001Medicaid