Family Diagnostic Medical Center,LLP

Primary specialty

Rural Health Clinic/CenterTaxonomy code 261QR1300X

Legal business name

FAMILY DIAGNOSTIC MEDICAL CENTER,LLP

Practice address

1323 E Franklin St
Suite 105
Hillsboro, TX 76645-2678

Phone

(254) 582-7481

Fax

(254) 582-1584

NPI assigned

Feb 23, 2006

Last updated

Mar 9, 2011By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mr. Gerardo Carbajal, MBA

Title

Administrator

Phone

(254) 580-1550

Specialties & licenses 2

Addresses

Other identifiers 3

Locations

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

{
    "created_epoch": "1140652800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1299628800000",
    "number": "1629044326",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1323 E FRANKLIN ST",
            "address_2": "SUITE 105",
            "city": "HILLSBORO",
            "state": "TX",
            "postal_code": "766452678",
            "telephone_number": "254-582-7481",
            "fax_number": "254-582-1584"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1323 E FRANKLIN ST",
            "address_2": "SUITE 105",
            "city": "HILLSBORO",
            "state": "TX",
            "postal_code": "766452678",
            "telephone_number": "254-582-7481",
            "fax_number": "254-582-1584"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAMILY DIAGNOSTIC MEDICAL CENTER,LLP",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-02-23",
        "last_updated": "2011-03-09",
        "status": "A",
        "authorized_official_last_name": "CARBAJAL",
        "authorized_official_first_name": "GERARDO",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "254-580-1550",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "MBA"
    },
    "taxonomies": [
        {
            "code": "173000000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Legal Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "093773201",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "093773204",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "093773203",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Toni Engram, D.D.S.
• Wynelle Rae Erickson, CRNA
• McKenna Erwin
• Ess of Hillsboro LLC
• Family Diagnostic Medical Center, LLP
• Garrett Lee Forero Morales, DPT
• Atemnkeng Forwang
• Susan Carrie Fry, LPC-A
• Travis Fuller, ATC
• Ryan R Gadi, RPH, MS, DPHARM

• Rural Health Clinic/Center in Hillsboro, TX
• Providers in Hillsboro, TX by specialty
• Rural Health Clinic/Center in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 9, 2011; 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.