Provider Demographics
NPI:1174556187
Name:FAMILY MEDICINE CENTER OF PAMPA PLLC
Entity type:Organization
Organization Name:FAMILY MEDICINE CENTER OF PAMPA PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:KATHY
Authorized Official - Middle Name:
Authorized Official - Last Name:CRAWFORD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:806-665-0801
Mailing Address - Street 1:3023 PERRYTON PKWY
Mailing Address - Street 2:SUITE 101
Mailing Address - City:PAMPA
Mailing Address - State:TX
Mailing Address - Zip Code:79065-2817
Mailing Address - Country:US
Mailing Address - Phone:806-665-0801
Mailing Address - Fax:806-665-8503
Practice Address - Street 1:3023 PERRYTON PKWY
Practice Address - Street 2:SUITE 101
Practice Address - City:PAMPA
Practice Address - State:TX
Practice Address - Zip Code:79065-2821
Practice Address - Country:US
Practice Address - Phone:806-665-0801
Practice Address - Fax:806-665-8503
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-10
Last Update Date:2008-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX83668601Medicaid
TXR17034OtherRADIOLOGY
TX00L20LOtherBCBS
TX45D0864498OtherCLIA
TX00L20LOtherRAILROAD MEDICARE GROUP
TX00L20LOtherRAILROAD MEDICARE GROUP
TX45D0864498OtherCLIA