Healthcare Provider Details

I. General information

NPI: 1013034347
Provider Name (Legal Business Name): MIDLAND ACADEMY CHARTER SCHOOL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/23/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 N BAIRD ST
MIDLAND TX
79701-4704
US

IV. Provider business mailing address

500 N BAIRD ST
MIDLAND TX
79701-4704
US

V. Phone/Fax

Practice location:
  • Phone: 432-686-0003
  • Fax: 432-686-0845
Mailing address:
  • Phone: 432-686-0003
  • Fax: 432-686-0845

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251300000X
TaxonomyLocal Education Agency (LEA)
License Number
License Number StateTX

VIII. Authorized Official

Name: MR. LEE C. CULVER
Title or Position: DIRECTOR
Credential:
Phone: 432-686-0003