Healthcare Provider Details

I. General information

NPI: 1548368400
Provider Name (Legal Business Name): FAMILY CARE CENTER QUITMAN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/21/2006
Last Update Date: 07/27/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

606 E GOODE STREET SUITE 100
QUITMAN TX
75783-2541
US

IV. Provider business mailing address

606 E GOODE STREET SUITE 100
QUITMAN TX
75783-2541
US

V. Phone/Fax

Practice location:
  • Phone: 903-763-2421
  • Fax: 903-763-0812
Mailing address:
  • Phone: 903-763-2421
  • Fax: 903-763-0812

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: SCOTT J OLSON
Title or Position: PRESIDENT
Credential: MD
Phone: 903-763-2421