MEDICARE: NORTH CENTRAL TEXAS FAMILY MEDICINE PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	L1474	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	0055KD	OTHER	TX	BCBS

General Provider Information

NPI Number	:	1194781757
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTH CENTRAL TEXAS FAMILY MEDICINE PA

Provider Business Mailing Address
First Line	:	800 MEDICAL CENTER DR
Second Line	:	SUITE C
City	:	DECATUR
State	:	TX
Zip	:	76234-3843
Country	:	US
Telephone Number	:	940-626-4475
Fax Number	:	940-626-4447

Provider Business Practice Location Address
First Line	:	800 MEDICAL CENTER DR
Second Line	:	SUITE C
City	:	DECATUR
State	:	TX
Zip	:	76234-3843
Country	:	US
Telephone Number	:	940-626-4475
Fax Number	:	940-626-4447

Authorized Official
Title or Position	:	PRESIDENT
Name	:	GARY D SWAIN
Credential	:	MD
Telephone Number	:	940-626-4475

Provider Enumeration Date	:	04/24/2006
Last Update Date	:	03/10/2011

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