Nacogdoches Family Practice, PA

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

NACOGDOCHES FAMILY PRACTICE, PA

Practice address

1023 N Mound St
Suite a
Nacogdoches, TX 75961-4491

Phone

(936) 564-2691

Fax

(936) 560-5224

NPI assigned

Feb 4, 2008

Organization subpart

No

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

Authorized official

Name

Edwin Emborgo, MD

Title

Owner

Phone

(936) 564-2691

Specialties & licenses 1

Addresses

Other identifiers 2

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

{
    "created_epoch": "1202083200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1277164800000",
    "number": "1235317082",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 630696",
            "city": "NACOGDOCHES",
            "state": "TX",
            "postal_code": "75963",
            "telephone_number": "936-553-2534",
            "fax_number": "713-634-2636"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1023 N MOUND ST",
            "address_2": "SUITE A",
            "city": "NACOGDOCHES",
            "state": "TX",
            "postal_code": "759614491",
            "telephone_number": "936-564-2691",
            "fax_number": "936-560-5224"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NACOGDOCHES FAMILY PRACTICE, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-02-04",
        "last_updated": "2010-06-22",
        "status": "A",
        "authorized_official_last_name": "EMBORGO",
        "authorized_official_first_name": "EDWIN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "936-564-2691",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TEXAS MEDICAL LICENSE",
            "identifier": "M8458",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "203713701",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Family Medicine Physician in Nacogdoches, TX
• Providers in Nacogdoches, TX by specialty
• Family Medicine Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 22, 2010; 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.