Provider Demographics
NPI:1053591909
Name:FAMILY PHYSICIANS OF WYLIE PA
Entity type:Organization
Organization Name:FAMILY PHYSICIANS OF WYLIE PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:A/R MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DOREEN
Authorized Official - Middle Name:
Authorized Official - Last Name:SHINN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-784-2800
Mailing Address - Street 1:801-A HWY 78, SUITE 201
Mailing Address - Street 2:
Mailing Address - City:WYLIE
Mailing Address - State:TX
Mailing Address - Zip Code:75098-4000
Mailing Address - Country:US
Mailing Address - Phone:972-429-1077
Mailing Address - Fax:972-429-1173
Practice Address - Street 1:801-A HWY 78, SUITE 201
Practice Address - Street 2:
Practice Address - City:WYLIE
Practice Address - State:TX
Practice Address - Zip Code:75098-4000
Practice Address - Country:US
Practice Address - Phone:972-429-1077
Practice Address - Fax:972-429-1173
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-08
Last Update Date:2007-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXI10683OtherUPIN
TX00W063Medicare PIN