| Lake Country Family Medicine, P.a. | |
|
8465 Boat Club Rd Suite 115 Fort Worth TX 76179-3607 | |
| (817) 260-0535 | |
| (817) 984-1448 |
| Full Name | Lake Country Family Medicine, P.a. |
|---|---|
| Speciality | Family Medicine |
| Location | 8465 Boat Club Rd, Fort Worth, Texas |
| Authorized Official Name and Position | Yung Sieu Chen (OWNER) |
| Authorized Official Contact | 8172600535 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Lake Country Family Medicine, P.a. 8465 Boat Club Rd Suite 115 Fort Worth TX 76179-3607 Ph: (817) 260-0535 | Lake Country Family Medicine, P.a. 8465 Boat Club Rd Suite 115 Fort Worth TX 76179-3607 Ph: (817) 260-0535 |
| NPI Number | 1629392063 |
|---|---|
| Provider Enumeration Date | 03/14/2010 |
| Last Update Date | 10/03/2023 |
| Medicare PECOS PAC ID | 2769515568 |
|---|---|
| Medicare Enrollment ID | O20100730000444 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1629392063 | NPI | - | NPPES |
| 2144495 | Medicaid | TX |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| 261QP2300X | Clinic/center - Primary Care | K7694 (Texas) | Secondary |
| Provider Name | Yung S Chen |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1366411845 PECOS PAC ID: 6800922584 Enrollment ID: I20100405000551 |
| Provider Name | Bianca Adrianna Agnello |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1275148793 PECOS PAC ID: 7719392471 Enrollment ID: I20210211000807 |
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