Organization
FAMILY MEDICINE RURAL HEALTH CLINIC, PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MARK S LANE M.D. (PHYSICIAN)
(512) 556-3621
Entity
Organization
Contact information
Practice address
187 PR 4060, LAMPASAS, TX 76550-4071
(512) 556-3621
(512) 556-6594
Mailing address
207 W AVENUE E, LAMPASAS, TX 76550-1820
(512) 556-3621
(512) 556-6594
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
208000000X
Pediatrics Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00U72J
BLUE CROSS/BLUE SHIELD
TX
05
—
121186401
—
TX
01
—
CG2858
RAILROAD MEDICARE
TX
Enumeration date
01/18/2007
Last updated
03/20/2017
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