Provider Demographics
NPI:1861719239
Name:LIVE OAK FAMILY HEALTH, P.A.
Entity type:Organization
Organization Name:LIVE OAK FAMILY HEALTH, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:JANE
Authorized Official - Last Name:SULLIVAN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:830-379-5200
Mailing Address - Street 1:205 N KING ST
Mailing Address - Street 2:STE 200
Mailing Address - City:SEGUIN
Mailing Address - State:TX
Mailing Address - Zip Code:78155-5836
Mailing Address - Country:US
Mailing Address - Phone:830-379-5200
Mailing Address - Fax:830-379-5201
Practice Address - Street 1:205 N KING ST
Practice Address - Street 2:STE 200
Practice Address - City:SEGUIN
Practice Address - State:TX
Practice Address - Zip Code:78155-5836
Practice Address - Country:US
Practice Address - Phone:830-379-5200
Practice Address - Fax:830-379-5201
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-26
Last Update Date:2015-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE6077208000000X
TXN3335207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty