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General NPI Number Information
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NPI Number | 1194781757
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Entity Type | Organization
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Legal Business Name | NORTH CENTRAL TEXAS FAMILY MEDICINE PA
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Dates
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Enumeration Date | 04/24/2006
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Last Update Date | 03/10/2011
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Provider Practice Location Address
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Address Line | 800 MEDICAL CENTER DR SUITE C
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City | DECATUR
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State | TX
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Zip | 76234-3843
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Country | US
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Telephone | 940-626-4475
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Fax | 940-626-4447
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Provider Business Mailing Address
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Address Line | 800 MEDICAL CENTER DR SUITE C
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City | DECATUR
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State | TX
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Zip | 76234-3843
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Country | US
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Telephone | 940-626-4475
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Fax | 940-626-4447
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Authorized Official
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Title or Position | PRESIDENT
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Name | GARY D SWAIN
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Credential | MD
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Telephone | 940-626-4475
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | L1474
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License Number State | TX
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