| Lgfm Pllc | |
|
1253 N Von Minden St La Grange TX 78945-1262 | |
| (979) 968-8493 | |
| (979) 968-6388 |
| Full Name | Lgfm Pllc |
|---|---|
| Speciality | Family Medicine |
| Location | 1253 N Von Minden St, La Grange, Texas |
| Authorized Official Name and Position | Alyson Beisert (CREDENTIALING ADMINISTRATOR) |
| Authorized Official Contact | 9799688493 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Lgfm Pllc 1253 N Von Minden St La Grange TX 78945-1262 Ph: (979) 968-8493 | Lgfm Pllc 1253 N Von Minden St La Grange TX 78945-1262 Ph: (979) 968-8493 |
| NPI Number | 1871153775 |
|---|---|
| Provider Enumeration Date | 06/13/2019 |
| Last Update Date | 06/13/2019 |
| Medicare PECOS PAC ID | 5395075238 |
|---|---|
| Medicare Enrollment ID | O20190919001583 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1871153775 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| 261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Secondary |
| Provider Name | Hans James Raj |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1205909074 PECOS PAC ID: 5395847719 Enrollment ID: I20070302000327 |
| Provider Name | Wess James Blackwell |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1780679662 PECOS PAC ID: 7719875657 Enrollment ID: I20070716000210 |
| Provider Name | Amy J Gutierrez |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1851395750 PECOS PAC ID: 4688731797 Enrollment ID: I20090317000279 |
| Provider Name | Thomas Owen Borgstedte |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1295877264 PECOS PAC ID: 4880792100 Enrollment ID: I20101029001192 |
| Provider Name | William Michael Mcbroom |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1407998461 PECOS PAC ID: 7113931437 Enrollment ID: I20110627000037 |
| Provider Name | Mohan Ravindra Gadam |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1356509004 PECOS PAC ID: 2769668573 Enrollment ID: I20111103000633 |
| Provider Name | Amanda Rosenauer |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1265873251 PECOS PAC ID: 7315181344 Enrollment ID: I20130913000038 |
| Provider Name | Emad Shoukry |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1053318857 PECOS PAC ID: 1759353337 Enrollment ID: I20141231001191 |
| Provider Name | Amanda Gail Cernosek |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1649718602 PECOS PAC ID: 9234407651 Enrollment ID: I20170607002513 |
| Provider Name | Kinuyo L Henderson |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1265843874 PECOS PAC ID: 6204195498 Enrollment ID: I20180116000893 |
| Provider Name | Aylene A Martinez |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1992211213 PECOS PAC ID: 0446511406 Enrollment ID: I20180308000444 |
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