Basic Information
| Provider Information | |||||||||
| NPI: | 1831251271 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | NORTH HILLS FAMILY PRACTICE, PA | ||||||||
| LastName: | |||||||||
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| Credential: | |||||||||
| OtherOrganizationName: | NORTH HILLS FAMILY MEDICINE | ||||||||
| OtherOrganizationType: | 3 | ||||||||
| OtherLastName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 4351 BOOTH CALLOWAY RD | ||||||||
| Address2: | SUITE 101 | ||||||||
| City: | NORTH RICHLAND HILLS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 761807378 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8172841165 | ||||||||
| FaxNumber: | 8172844990 | ||||||||
| Practice Location | |||||||||
| Address1: | 4351 BOOTH CALLOWAY RD | ||||||||
| Address2: | SUITE 101 | ||||||||
| City: | NORTH RICHLAND HILLS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 761807378 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8172841165 | ||||||||
| FaxNumber: | 8172844990 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/14/2006 | ||||||||
| LastUpdateDate: | 03/12/2020 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | GAUWAIN | ||||||||
| AuthorizedOfficialFirstName: | CHRISTINE | ||||||||
| AuthorizedOfficialMiddleName: | SUSAN | ||||||||
| AuthorizedOfficialTitleorPosition: | ADMINISTRATIVE ASSISTANT | ||||||||
| AuthorizedOfficialTelephone: | 8172846912 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 03/12/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | H8646 | 01 | TX | MEDICAL LICENSE- DR FULLER | OTHER | F1559 | 01 | TX | MEDICAL LICENSE-DR GABRIEL | OTHER | K1233 | 01 | TX | MEDICAL LICENSE-DR LAMBERT | OTHER | L8368 | 01 | TX | MEDICAL LICENSE-DR MARTIN | OTHER |