Provider Demographics
NPI:1306887104
Name:KILLEEN FAMILY HEALTH AND URGENT CARE, PA
Entity type:Organization
Organization Name:KILLEEN FAMILY HEALTH AND URGENT CARE, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:THIKRA
Authorized Official - Middle Name:J
Authorized Official - Last Name:KADHIM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:254-200-9355
Mailing Address - Street 1:PO BOX 938
Mailing Address - Street 2:
Mailing Address - City:KILLEEN
Mailing Address - State:TX
Mailing Address - Zip Code:76540-0938
Mailing Address - Country:US
Mailing Address - Phone:254-634-6999
Mailing Address - Fax:254-200-4090
Practice Address - Street 1:4520 E CENTRAL TEXAS EXPY
Practice Address - Street 2:STE 101
Practice Address - City:KILLEEN
Practice Address - State:TX
Practice Address - Zip Code:76543-5276
Practice Address - Country:US
Practice Address - Phone:254-200-9355
Practice Address - Fax:254-200-9356
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0017NEOtherBLUE CROSS BLUE SHIELD
TX0017NEOtherBLUE CROSS BLUE SHIELD