Provider Demographics
NPI:1124105994
Name:A 1 FAMILY HEALTH CENTER PA
Entity type:Organization
Organization Name:A 1 FAMILY HEALTH CENTER PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:HINES
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:281-427-6363
Mailing Address - Street 1:PO BOX 690
Mailing Address - Street 2:
Mailing Address - City:BAYTOWN
Mailing Address - State:TX
Mailing Address - Zip Code:77522-0690
Mailing Address - Country:US
Mailing Address - Phone:281-427-6363
Mailing Address - Fax:281-420-6867
Practice Address - Street 1:2610 N ALEXANDER DR
Practice Address - Street 2:SUITE 201
Practice Address - City:BAYTOWN
Practice Address - State:TX
Practice Address - Zip Code:77520-3368
Practice Address - Country:US
Practice Address - Phone:281-427-6363
Practice Address - Fax:281-420-6867
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2007-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00527YMedicare PIN