ICW TA NPI 1770660136

NPI Information

  • NPI: 1770660136
  • Provider Name: ICW TA
  • Classification: Physician Assistant - 363AM0700X
  • Specialization: Medical
  • Entity Type: Organization
  • Doing Business As: FAMILY HEALTH CLINIC OF TEXOMA
  • Address: 1411 13TH ST
    WICHITA FALLS, TX
    ZIP 76301
  • Phone: (940) 851-9900

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NPI Details

ICW TA is a medical physician assistant in Wichita Falls, TX. ICW TA NPI is 1770660136. The provider is registered as an organization entity type and is a single specialty group.
The provider Is Doing Business As Family Health Clinic Of Texoma.

The provider's business location address is:

1411 13TH ST
WICHITA FALLS, TX
ZIP 76301-100
Phone: (940) 851-9900
Fax: (940) 851-8089

The provider's authorized official is Robert Shawn Smith .
The authorized official title is Owner and has the following contact phone number (940) 851-9900.

The enumeration date for this NPI number is 11/1/2006 and was last updated on 11/6/2008.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1363AM0700XPhysician AssistantMedicalPA00159TEXASYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
117262701MEDICAIDTEXAS
2172462702MEDICAIDTEXAS
300410YMEDICARE PINTEXAS
400410YMEDICARE ID-TYPE UNSPECIFIEDTEXASMEDICARE PROVIDER NUMBER
50056MGOTHERTEXASBCBS

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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