Provider Demographics
NPI:1982063012
Name:CHRISTOPHER G HISEL MD PA
Entity Type:Organization
Organization Name:CHRISTOPHER G HISEL MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:
Authorized Official - Last Name:HISEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:806-544-7618
Mailing Address - Street 1:706 E FELT ST
Mailing Address - Street 2:
Mailing Address - City:BROWNFIELD
Mailing Address - State:TX
Mailing Address - Zip Code:79316-3440
Mailing Address - Country:US
Mailing Address - Phone:806-637-0344
Mailing Address - Fax:806-637-1117
Practice Address - Street 1:706 E FELT ST
Practice Address - Street 2:
Practice Address - City:BROWNFIELD
Practice Address - State:TX
Practice Address - Zip Code:79316-3440
Practice Address - Country:US
Practice Address - Phone:806-637-0344
Practice Address - Fax:806-637-1117
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-17
Last Update Date:2016-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK7764207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX031142502Medicaid
TX031142502Medicaid