Provider Demographics
NPI:1982746673
Name:BRENHAM FAMILY CARE, PLLC
Entity Type:Organization
Organization Name:BRENHAM FAMILY CARE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE ADMINISTRATION
Authorized Official - Prefix:MRS
Authorized Official - First Name:EDNA
Authorized Official - Middle Name:M
Authorized Official - Last Name:BUSTOS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:979-830-1441
Mailing Address - Street 1:605 MEDICAL CT STE 201
Mailing Address - Street 2:
Mailing Address - City:BRENHAM
Mailing Address - State:TX
Mailing Address - Zip Code:77833-5406
Mailing Address - Country:US
Mailing Address - Phone:979-830-1441
Mailing Address - Fax:979-830-1369
Practice Address - Street 1:605 MEDICAL CT STE 201
Practice Address - Street 2:
Practice Address - City:BRENHAM
Practice Address - State:TX
Practice Address - Zip Code:77833-5406
Practice Address - Country:US
Practice Address - Phone:979-830-1441
Practice Address - Fax:979-830-1369
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-12
Last Update Date:2009-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX525996363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0062LCOtherBCBS
TX165150701Medicaid
TX165150701Medicaid