Texan Family Health LLC
Organization Active NPI Family Nurse Practitioner · Strawn, TX
NPI 1972255156 · NPPES record last updated Sep 7, 2022
Key facts
- NPI
- 1972255156
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Family Nurse Practitioner 363LF0000X
- Legal business name
- TEXAN FAMILY HEALTH LLC
- Practice address
- 119 Central Ave
Strawn, TX 76475-5124 - Phone
- (254) 977-2556
- NPI assigned
- Jan 19, 2022
- Organization subpart
- No
Authorized official
- Name
- Brett Wayne Thetford
- Title
- Owner
- Phone
- (254) 977-2556
Practitioners 3
-
Charles Jordan, FNP-C
-
Brett Wayne Thetford, FNP-C
-
Shawntay Sparks, ACNP-BC
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 45D2248587 | Texan Family Health | Certificate of waiver | Jan 13, 2028 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in TX
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20220301001968 | TX | Part B Supplier - Clinic/Group Practice | 8729472139 |
Receives reassigned benefits from 3 practitioners Practice locations: Strawn, TX |
National Provider Directory
Interoperability endpoints
- https://api.platform.athenahealth.com/25154/brand/1/csg/1/fhir/r4
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner |
363LF0000X | Yes |
Addresses
Primary practice location
119 Central Ave
Strawn, TX 76475-5124
Mailing address
119 Central Ave
Strawn, TX 76475-5124
Other providers in Strawn, TX
All providers in Strawn, TX · Family Nurse Practitioner in Texas
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 7, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.