=====================================================
General NPI Number Information
=====================================================
NPI Number | 1316950546
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HOUSTON FAMILY HEALTH, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/15/2006
-----------------------------------------------------
Last Update Date | 06/01/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 116 TOMMY STALNAKER DR BLDG A
-----------------------------------------------------
City | WARNER ROBINS
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 31088-8983
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 478-953-1999
-----------------------------------------------------
Fax | 478-953-0737
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 8909
-----------------------------------------------------
City | WARNER ROBINS
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 31095-8909
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 478-953-1999
-----------------------------------------------------
Fax | 478-953-0737
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. WILLIAM O. RANKINE JR.
-----------------------------------------------------
Credential | DO
-----------------------------------------------------
Telephone | 478-953-1999
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | 055294
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------