Provider Demographics
NPI:1952591364
Name:CEDAR PARK FAMILY PRACTICE, P.A.
Entity Type:Organization
Organization Name:CEDAR PARK FAMILY PRACTICE, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BING
Authorized Official - Middle Name:GET
Authorized Official - Last Name:YEE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:512-249-0880
Mailing Address - Street 1:200 S BELL BLVD
Mailing Address - Street 2:STE B-4
Mailing Address - City:CEDAR PARK
Mailing Address - State:TX
Mailing Address - Zip Code:78613-2910
Mailing Address - Country:US
Mailing Address - Phone:512-249-0880
Mailing Address - Fax:512-249-5053
Practice Address - Street 1:200 S BELL BLVD
Practice Address - Street 2:STE B-4
Practice Address - City:CEDAR PARK
Practice Address - State:TX
Practice Address - Zip Code:78613-2910
Practice Address - Country:US
Practice Address - Phone:512-249-0880
Practice Address - Fax:512-249-5053
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-01
Last Update Date:2007-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ1590261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1813578Medicaid
TX1813578Medicaid