Provider Demographics
NPI:1447695762
Name:FAITH FAMILY CLINIC
Entity type:Organization
Organization Name:FAITH FAMILY CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:A
Authorized Official - Last Name:YOUNG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-653-1511
Mailing Address - Street 1:8711 VILLAGE DR
Mailing Address - Street 2:SUITE 305
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78217-5418
Mailing Address - Country:US
Mailing Address - Phone:210-653-1511
Mailing Address - Fax:210-653-9141
Practice Address - Street 1:700 S ZARZAMORA ST
Practice Address - Street 2:SUITE LL1
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78207-5255
Practice Address - Country:US
Practice Address - Phone:210-653-1511
Practice Address - Fax:210-653-9141
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-30
Last Update Date:2014-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care