Healthcare Provider Details

I. General information

NPI: 1629007281
Provider Name (Legal Business Name): BIG COUNTRY FAMILY CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/03/2006
Last Update Date: 10/24/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 KENSHALO
ALBANY TX
76430
US

IV. Provider business mailing address

P.O. BOX 1544
ALBANY TX
76430-1544
US

V. Phone/Fax

Practice location:
  • Phone: 325-762-3661
  • Fax: 325-762-3859
Mailing address:
  • Phone: 325-762-3661
  • Fax: 325-762-3859

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MRS. ANGELA DENISE MOORE
Title or Position: OFFICE MANAGER
Credential:
Phone: 325-762-3661