Provider Demographics
NPI:1316950546
Name:HOUSTON FAMILY HEALTH, LLC
Entity type:Organization
Organization Name:HOUSTON FAMILY HEALTH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:O
Authorized Official - Last Name:RANKINE
Authorized Official - Suffix:JR
Authorized Official - Credentials:DO
Authorized Official - Phone:478-953-1999
Mailing Address - Street 1:PO BOX 8909
Mailing Address - Street 2:
Mailing Address - City:WARNER ROBINS
Mailing Address - State:GA
Mailing Address - Zip Code:31095-8909
Mailing Address - Country:US
Mailing Address - Phone:478-953-1999
Mailing Address - Fax:478-953-0737
Practice Address - Street 1:116 TOMMY STALNAKER DR
Practice Address - Street 2:BLDG A
Practice Address - City:WARNER ROBINS
Practice Address - State:GA
Practice Address - Zip Code:31088-8983
Practice Address - Country:US
Practice Address - Phone:478-953-1999
Practice Address - Fax:478-953-0737
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-15
Last Update Date:2009-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA055294207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GADF0800OtherRAILROAD MEDICARE GROUP #
GAGRP 7804OtherMEDICARE GROUP NUMBER
GA701989215AMedicaid
GA701989215AMedicaid
GA08CBBTDMedicare PIN