Provider Demographics
NPI:1194781757
Name:NORTH CENTRAL TEXAS FAMILY MEDICINE PA
Entity type:Organization
Organization Name:NORTH CENTRAL TEXAS FAMILY MEDICINE PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GARY
Authorized Official - Middle Name:D
Authorized Official - Last Name:SWAIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:940-626-4475
Mailing Address - Street 1:800 MEDICAL CENTER DR
Mailing Address - Street 2:SUITE C
Mailing Address - City:DECATUR
Mailing Address - State:TX
Mailing Address - Zip Code:76234-3843
Mailing Address - Country:US
Mailing Address - Phone:940-626-4475
Mailing Address - Fax:940-626-4447
Practice Address - Street 1:800 MEDICAL CENTER DR
Practice Address - Street 2:SUITE C
Practice Address - City:DECATUR
Practice Address - State:TX
Practice Address - Zip Code:76234-3843
Practice Address - Country:US
Practice Address - Phone:940-626-4475
Practice Address - Fax:940-626-4447
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-24
Last Update Date:2011-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL1474207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX160002501Medicaid
TX0055KDOtherBCBS
TX00335VMedicare PIN