Healthcare Provider Details

I. General information

NPI: 1841628211
Provider Name (Legal Business Name): WEST TEXAS FAMILY MEDICINE, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/23/2013
Last Update Date: 06/19/2020
Certification Date: 06/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1806 QUINCY ST
PLAINVIEW TX
79072-4206
US

IV. Provider business mailing address

1806 QUINCY ST
PLAINVIEW TX
79072-4206
US

V. Phone/Fax

Practice location:
  • Phone: 806-288-7891
  • Fax: 806-288-7920
Mailing address:
  • Phone: 806-288-7891
  • Fax: 806-288-7920

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License NumberR40503
License Number StateTX
# 4
Primary TaxonomyN
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number45D2116379
License Number StateTX
# 6
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 7
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MARIA GRACIELA ORTEGA
Title or Position: BILLING MANAGER
Credential:
Phone: 806-213-9560