Provider Demographics
NPI:1386744142
Name:AIRLINE FAMILY PRACTICE ASSOCIATES, INC
Entity type:Organization
Organization Name:AIRLINE FAMILY PRACTICE ASSOCIATES, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:I
Authorized Official - Last Name:GONZALEZ
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:713-447-1375
Mailing Address - Street 1:11012 AIRLINE DR STE A
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77037-1112
Mailing Address - Country:US
Mailing Address - Phone:281-820-8955
Mailing Address - Fax:281-820-5541
Practice Address - Street 1:11012 AIRLINE DR STE A
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77037-1112
Practice Address - Country:US
Practice Address - Phone:281-820-8955
Practice Address - Fax:281-820-5541
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-22
Last Update Date:2023-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX180218301Medicaid
TX0076NPOtherBCBS GROUP
TX180218302Medicaid
TX00W230Medicare PIN