Healthcare Provider Details

I. General information

NPI: 1699731257
Provider Name (Legal Business Name): FAMILY MEDICINE RURAL HEALTH CLINIC PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/24/2006
Last Update Date: 03/20/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

187 PR 4060
LAMPASAS TX
76550-4071
US

IV. Provider business mailing address

207 W AVENUE E
LAMPASAS TX
76550-1820
US

V. Phone/Fax

Practice location:
  • Phone: 512-556-3621
  • Fax: 512-556-6594
Mailing address:
  • Phone: 512-556-3621
  • Fax: 512-556-6594

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. MARK S LANE
Title or Position: PHYSICIAN
Credential: M.D.
Phone: 512-556-3621