Provider Demographics
NPI:1912229956
Name:FAMILY MEDICINE OF NORTH TEXAS, P.A.
Entity Type:Organization
Organization Name:FAMILY MEDICINE OF NORTH TEXAS, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:GILLIS
Authorized Official - Last Name:PURGASON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:817-917-9687
Mailing Address - Street 1:2601 SCRIPTURE ST STE 102
Mailing Address - Street 2:
Mailing Address - City:DENTON
Mailing Address - State:TX
Mailing Address - Zip Code:76201-4322
Mailing Address - Country:US
Mailing Address - Phone:940-442-6455
Mailing Address - Fax:940-442-6606
Practice Address - Street 1:2601 SCRIPTURE ST STE 102
Practice Address - Street 2:
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76201-4322
Practice Address - Country:US
Practice Address - Phone:940-442-6455
Practice Address - Fax:940-442-6606
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-18
Last Update Date:2016-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ6672207Q00000X, 261QP2300X
TXM88582084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary CareGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX04231501Medicaid
TX1962472449OtherNPI
TX1962472449OtherNPI
TX04231501Medicaid