=====================================================
General NPI Number Information
=====================================================
NPI Number | 1699513895
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | TALEM FAMILY CLINIC PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/20/2024
-----------------------------------------------------
Last Update Date | 04/16/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5600 S VETERANS BLVD SUITE C
-----------------------------------------------------
City | EDINBURG
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78542
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 956-450-2625
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5600 S VETERANS BLVD STE C
-----------------------------------------------------
City | EDINBURG
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78542-7731
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 956-270-1650
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | LIJI THOMAS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 956-270-1650
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------