Provider Demographics
NPI:1558658245
Name:NORTH TEXAS FAMILY CARE ASSOCIATES PA
Entity type:Organization
Organization Name:NORTH TEXAS FAMILY CARE ASSOCIATES PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SABA
Authorized Official - Middle Name:
Authorized Official - Last Name:SHABNAM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:817-421-9999
Mailing Address - Street 1:PO BOX 2166
Mailing Address - Street 2:
Mailing Address - City:GRAPEVINE
Mailing Address - State:TX
Mailing Address - Zip Code:76099-2166
Mailing Address - Country:US
Mailing Address - Phone:817-421-9999
Mailing Address - Fax:817-421-9910
Practice Address - Street 1:823 IRA E WOODS AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:GRAPEVINE
Practice Address - State:TX
Practice Address - Zip Code:76051-4083
Practice Address - Country:US
Practice Address - Phone:817-421-9999
Practice Address - Fax:817-421-9910
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-01
Last Update Date:2011-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0002WVOtherBCBS GROUP
TX0002WVOtherBCBS GROUP