Provider Demographics
NPI:1063526945
Name:UVALDE FAMILY PRACTICE ASSOCIATION
Entity type:Organization
Organization Name:UVALDE FAMILY PRACTICE ASSOCIATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:P
Authorized Official - Last Name:WEGRZYN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:830-278-4453
Mailing Address - Street 1:1800 GARNER FIELD RD
Mailing Address - Street 2:
Mailing Address - City:UVALDE
Mailing Address - State:TX
Mailing Address - Zip Code:78801-6210
Mailing Address - Country:US
Mailing Address - Phone:830-278-4453
Mailing Address - Fax:830-278-3427
Practice Address - Street 1:1800 GARNER FIELD RD
Practice Address - Street 2:
Practice Address - City:UVALDE
Practice Address - State:TX
Practice Address - Zip Code:78801-6210
Practice Address - Country:US
Practice Address - Phone:830-278-4453
Practice Address - Fax:830-278-3427
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-18
Last Update Date:2017-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP6748207Q00000X
TXG6787207Q00000X
TXH0376207Q00000X, 2083P0901X
261QP2300X, 291U00000X, 305R00000X, 261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive MedicineGroup - Multi-Specialty
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No291U00000XLaboratoriesClinical Medical Laboratory
No305R00000XManaged Care OrganizationsPreferred Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00L82SOtherGROUP BCBS
TX083850001Medicaid
TX063389301Medicaid
TX017801401Medicaid
TX017801401Medicaid
TX063389301Medicaid
TX87V600OtherINDIVIDUAL BCBS NUMBER
TX0838500001Medicaid
TX453835OtherMEDICARE GROUP PART A