MEDICARE: KIM LISA BANGO MD PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	M3462	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1477595866
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KIM LISA BANGO MD PA

Provider Business Mailing Address
First Line	:	1608 W FM 700
Second Line	:	SUITE D
City	:	BIG SPRING
State	:	TX
Zip	:	79720-4105
Country	:	US
Telephone Number	:	432-263-0500
Fax Number	:	432-263-0501

Provider Business Practice Location Address
First Line	:	1608 W FM 700
Second Line	:	SUITE D
City	:	BIG SPRING
State	:	TX
Zip	:	79720-4105
Country	:	US
Telephone Number	:	432-263-0500
Fax Number	:	432-263-0501

Authorized Official
Title or Position	:	OWNER
Name	:	DR. KIM LISA BANGO
Credential	:	M.D.
Telephone Number	:	432-263-0500

Provider Enumeration Date	:	06/12/2006
Last Update Date	:	04/13/2010

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Directions to “KIM LISA BANGO MD PA ” Practice Location

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