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NPI Code Detail

MEDICARE: FAMILY MEDICINE RURAL HEALTH CLINIC, PA

MEDICARE: FAMILY MEDICINE RURAL HEALTH CLINIC, 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
1208000000XPediatrics Physician
2261QR1300XRural Health Clinic/CenterTX
3207Q00000XFamily Medicine Physician

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
3458905OTHERTXRHC MEDICARE ID
400U72JOTHERTXMEDICARE B

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1700150869
Entity Type Code : Organization
Provider Name (Legal Business Name) : FAMILY MEDICINE RURAL HEALTH CLINIC, PA
Provider Business Mailing Address
First Line : 207 W AVENUE E
Second Line :
City : LAMPASAS
State : TX
Zip : 76550-1820
Country : US
Telephone Number : 512-556-3621
Fax Number : 512-556-4080
Provider Business Practice Location Address
First Line : 2401 WALKER PLACE BLVD
Second Line :
City : COPPERAS COVE
State : TX
Zip : 76522-4025
Country : US
Telephone Number : 254-547-5516
Fax Number : 254-542-0039
Authorized Official
Title or Position : PRESIDENT
Name : MARK S LANE
Credential : MD
Telephone Number : 512-556-3621
Provider Enumeration Date : 03/06/2012
Last Update Date : 03/20/2017

Similar Medicare Providers

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1790710259 — MR. WILLIAM FRANKLIN MONTGOMERY JR. PA
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1790042406 — MR. RICHARD DEAN CALKINS FNP
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1114353117 — JAMIE LEANN JONES FNP-C
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1720554819 — JASMINE A MORGAN FNP-C
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1699332338 — ADVENTHEALTH FAMILY MEDICINE RURAL HEALTH CLINICS, INC.
Practice Location Address:
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Practice Fax: 254-542-0039

Directions to “FAMILY MEDICINE RURAL HEALTH CLINIC, PA ” Practice Location

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