Provider Demographics
NPI:1417174921
Name:ROSEDALE FAMILY CARE PARTNERS, PA
Entity type:Organization
Organization Name:ROSEDALE FAMILY CARE PARTNERS, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:KRYSTAL
Authorized Official - Middle Name:
Authorized Official - Last Name:BUCHANAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-459-9889
Mailing Address - Street 1:5222 BURNET RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78756-2430
Mailing Address - Country:US
Mailing Address - Phone:512-459-9889
Mailing Address - Fax:512-459-7373
Practice Address - Street 1:5222 BURNET RD
Practice Address - Street 2:SUITE 200
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78756-2430
Practice Address - Country:US
Practice Address - Phone:512-459-9889
Practice Address - Fax:512-389-2935
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-19
Last Update Date:2024-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8F1441OtherKEINARTH BCBS
TX8F1440OtherMARGOLIN BCBS
TX8F1441OtherKEINARTH BCBS