Basic Information
| Provider Information | |||||||||
| NPI: | 1609967678 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | AFFILIATES OF FAMILY MEDICINE INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 503 MEDICAL CENTER BLVD | ||||||||
| Address2: | STE 100 | ||||||||
| City: | CONROE | ||||||||
| State: | TX | ||||||||
| PostalCode: | 773042928 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9367881060 | ||||||||
| FaxNumber: | 9367882844 | ||||||||
| Practice Location | |||||||||
| Address1: | 503 MEDICAL CENTER BLVD | ||||||||
| Address2: | STE 100 | ||||||||
| City: | CONROE | ||||||||
| State: | TX | ||||||||
| PostalCode: | 773042928 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9367881060 | ||||||||
| FaxNumber: | 9367882844 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/27/2006 | ||||||||
| LastUpdateDate: | 05/16/2016 | ||||||||
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| AuthorizedOfficialLastName: | GARCIA-SEAY M.D. | ||||||||
| AuthorizedOfficialFirstName: | LETICIA | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 9367881060 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | L1050 | TX | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | K2023 | TX | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 150961401 | 05 | TX | MEDICAID | CK5861 | 01 | TX | RAILROAD MEDICARE | OTHER | 00949R | 01 | TX | BLUE CROSS BLUE SHIELD | OTHER | 150961402 | 05 | TX | MEDICAID |