Organization
FAMILY MEDICINE RURAL HEALTH CLINIC, PA
Active
Other names
Family Medicine Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
MARK S LANE MD (PRESIDENT)
(512) 556-3621
Entity
Organization
Contact information
Practice address
2401 WALKER PLACE BLVD, COPPERAS COVE, TX 76522-4025
(254) 547-5516
(254) 542-0039
Mailing address
207 W AVENUE E, LAMPASAS, TX 76550-1820
(512) 556-3621
(512) 556-4080
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
208000000X
Pediatrics Physician
—
—
261QR1300X
Rural Health Clinic/Center
—
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00U72J
MEDICARE B
TX
05
—
121186401
—
TX
05
—
121186402
—
TX
05
—
121186403
—
TX
01
—
458905
RHC MEDICARE ID
TX
Enumeration date
03/06/2012
Last updated
03/20/2017
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