Provider Demographics
NPI:1538442603
Name:TOTAL CARE FAMILY PRACTICE, LLC
Entity type:Organization
Organization Name:TOTAL CARE FAMILY PRACTICE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LAB DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:
Authorized Official - Last Name:STUBBLEFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-295-9090
Mailing Address - Street 1:1200 E DAVIS ST STE 113
Mailing Address - Street 2:
Mailing Address - City:MESQUITE
Mailing Address - State:TX
Mailing Address - Zip Code:75149-8711
Mailing Address - Country:US
Mailing Address - Phone:972-295-9090
Mailing Address - Fax:972-534-0010
Practice Address - Street 1:1200 E DAVIS ST STE 113
Practice Address - Street 2:
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75149-8711
Practice Address - Country:US
Practice Address - Phone:972-295-9090
Practice Address - Fax:972-534-0010
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-24
Last Update Date:2022-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX061252511Medicaid
TX061252511Medicaid