MEDICARE: FIRST FAMILY CARE, PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1154666758
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FIRST FAMILY CARE, PLLC

Provider Business Mailing Address
First Line	:	1212 N HIGHWAY 377 STE 119
Second Line	:
City	:	ROANOKE
State	:	TX
Zip	:	76262-6916
Country	:	US
Telephone Number	:	682-831-1591
Fax Number	:	682-831-1598

Provider Business Practice Location Address
First Line	:	1212 N HIGHWAY 377 STE 119
Second Line	:
City	:	ROANOKE
State	:	TX
Zip	:	76262-6916
Country	:	US
Telephone Number	:	682-831-1591
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	PRAKASH BHAKTA
Credential	:	DC
Telephone Number	:	682-831-1591

Provider Enumeration Date	:	12/07/2012
Last Update Date	:	06/10/2013

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