Provider Demographics
NPI:1538410956
Name:TERESA H. KINSFATHER, D.O., P.A.
Entity type:Organization
Organization Name:TERESA H. KINSFATHER, D.O., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:D.O./OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:H
Authorized Official - Last Name:KINSFATHER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:979-542-4357
Mailing Address - Street 1:PO BOX 390
Mailing Address - Street 2:
Mailing Address - City:GIDDINGS
Mailing Address - State:TX
Mailing Address - Zip Code:78942-0390
Mailing Address - Country:US
Mailing Address - Phone:979-542-4357
Mailing Address - Fax:979-542-1010
Practice Address - Street 1:514 S MAIN ST
Practice Address - Street 2:
Practice Address - City:GIDDINGS
Practice Address - State:TX
Practice Address - Zip Code:78942-4118
Practice Address - Country:US
Practice Address - Phone:979-542-4357
Practice Address - Fax:979-542-1010
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-25
Last Update Date:2012-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX137322705Medicaid