NPIMap

Organization Active NPI

Medical Parkway Family Practice,LLP

  • Family Medicine Physician
  • Waco, TX
National Provider Identifier
1104996735
Registry record updated Apr 22, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
MEDICAL PARKWAY FAMILY PRACTICE,LLP
Practice address
318 Richland West Cir
Suite a
Waco, TX 76712-7919
Phone
(254) 776-8008
Fax
(254) 776-6892
NPI assigned
Nov 9, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 22, 2009

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Lisa Johnson Kirk, D.O.NPI 1578562146
Title
Physician/Owner
Phone
(254) 776-8008

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X Primary

Addresses

Primary practice location

318 Richland West Cir
Suite a
Waco, TX 76712-7919

Mailing address

318 Richland West Cir
Suite a
Waco, TX 76712-7919
Phone (254) 776-8008

Other identifiers 1

IdentifierTypeStateIssuer
151015803MedicaidTX

Other names 1

  • BRAZOS FAMILY MEDICINE Doing business as

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1163030400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1240358400000",
    "number": "1104996735",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "318 RICHLAND WEST CIR",
            "address_2": "SUITE A",
            "city": "WACO",
            "state": "TX",
            "postal_code": "767127919",
            "telephone_number": "254-776-8008",
            "fax_number": "254-776-6892"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "318 RICHLAND WEST CIR",
            "address_2": "SUITE A",
            "city": "WACO",
            "state": "TX",
            "postal_code": "767127919",
            "telephone_number": "254-776-8008",
            "fax_number": "254-776-6892"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEDICAL PARKWAY FAMILY PRACTICE,LLP",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-09",
        "last_updated": "2009-04-22",
        "status": "A",
        "authorized_official_last_name": "KIRK",
        "authorized_official_first_name": "LISA",
        "authorized_official_middle_name": "JOHNSON",
        "authorized_official_title_or_position": "PHYSICIAN/OWNER",
        "authorized_official_telephone_number": "254-776-8008",
        "authorized_official_credential": "D.O."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "151015803",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "BRAZOS FAMILY MEDICINE",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Waco, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 22, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.