Healthcare Provider Details

I. General information

NPI: 1154666758
Provider Name (Legal Business Name): FIRST FAMILY CARE, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/07/2012
Last Update Date: 06/10/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1212 N HIGHWAY 377 STE 119
ROANOKE TX
76262-6916
US

IV. Provider business mailing address

1212 N HIGHWAY 377 STE 119
ROANOKE TX
76262-6916
US

V. Phone/Fax

Practice location:
  • Phone: 682-831-1591
  • Fax:
Mailing address:
  • Phone: 682-831-1591
  • Fax: 682-831-1598

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: PRAKASH BHAKTA
Title or Position: OWNER
Credential: DC
Phone: 682-831-1591