Healthcare Provider Details

I. General information

NPI: 1770804791
Provider Name (Legal Business Name): MUENSTER FAMILY MEDICAL CLINIC, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/14/2010
Last Update Date: 10/15/2020
Certification Date: 10/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

134 S MESQUITE ST
MUENSTER TX
76252-2605
US

IV. Provider business mailing address

PO BOX 647 134 S MESQUITE ST.
MUENSTER TX
76252-0647
US

V. Phone/Fax

Practice location:
  • Phone: 940-759-2502
  • Fax: 940-759-3608
Mailing address:
  • Phone: 940-759-2502
  • Fax: 940-759-3608

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA01436
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number651571
License Number StateTX

VIII. Authorized Official

Name: MRS. AMY M DANGELMAYR
Title or Position: NURSE PRACTIONER
Credential: FNPC
Phone: 940-759-2502