Provider Demographics
NPI:1710593413
Name:WHITESBORO FAMILY MEDICAL CLINIC LLC
Entity type:Organization
Organization Name:WHITESBORO FAMILY MEDICAL CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:
Authorized Official - Last Name:DANGELMAYR
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:903-564-3503
Mailing Address - Street 1:304 CHARLIE ST
Mailing Address - Street 2:
Mailing Address - City:WHITESBORO
Mailing Address - State:TX
Mailing Address - Zip Code:76273-1103
Mailing Address - Country:US
Mailing Address - Phone:903-564-3503
Mailing Address - Fax:
Practice Address - Street 1:304 CHARLIE ST
Practice Address - Street 2:
Practice Address - City:WHITESBORO
Practice Address - State:TX
Practice Address - Zip Code:76273-1103
Practice Address - Country:US
Practice Address - Phone:903-564-3503
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-17
Last Update Date:2020-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty