Provider Demographics
NPI:1861721045
Name:MEDICAL FAMILY CIRCLE, PLLC
Entity type:Organization
Organization Name:MEDICAL FAMILY CIRCLE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:K
Authorized Official - Last Name:VILLANUEVA
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:972-869-3789
Mailing Address - Street 1:992 E US HIGHWAY 80
Mailing Address - Street 2:SUITE C
Mailing Address - City:FORNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75126-8709
Mailing Address - Country:US
Mailing Address - Phone:972-552-2920
Mailing Address - Fax:972-552-2930
Practice Address - Street 1:992 E US HIGHWAY 80
Practice Address - Street 2:SUITE C
Practice Address - City:FORNEY
Practice Address - State:TX
Practice Address - Zip Code:75126-8709
Practice Address - Country:US
Practice Address - Phone:972-552-2920
Practice Address - Fax:972-552-2930
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-16
Last Update Date:2011-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM9721207Q00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX216732201Medicaid
TX216732201Medicaid