MEDICARE: FAMILY MEDICINE OF ROCKPORT

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	261QH0100X	Health Service Clinic/Center

General Provider Information

NPI Number	:	1326220203
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FAMILY MEDICINE OF ROCKPORT

Provider Business Mailing Address
First Line	:	PO BOX 1865
Second Line	:
City	:	ROCKPORT
State	:	TX
Zip	:	78381-1865
Country	:	US
Telephone Number	:	361-790-5233
Fax Number	:	361-790-5241

Provider Business Practice Location Address
First Line	:	2871 HIGHWAY 35 N
Second Line	:
City	:	ROCKPORT
State	:	TX
Zip	:	78382-5712
Country	:	US
Telephone Number	:	361-790-5233
Fax Number	:	361-790-5241

Authorized Official
Title or Position	:	OWNER
Name	:	RACHEL D MAYBERRY
Credential	:
Telephone Number	:	361-790-5233

Provider Enumeration Date	:	12/03/2007
Last Update Date	:	12/03/2007

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Directions to “FAMILY MEDICINE OF ROCKPORT ” Practice Location

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