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General NPI Number Information
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NPI Number | 1245299353
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Entity Type | Organization
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Legal Business Name | MIDLAND MEDICAL GROUP PA
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Dates
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Enumeration Date | 03/20/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 25 VILLAGE CIRCLE
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City | MIDLAND
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State | TX
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Zip | 79701
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Country | US
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Telephone | 432-571-7016
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Fax | 432-571-7071
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Provider Business Mailing Address
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Address Line | PO BOX 2080
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City | MIDLAND
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State | TX
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Zip | 79702-2080
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Country | US
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Telephone | 432-571-7016
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Fax | 432-571-7071
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Authorized Official
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Title or Position | MANAGING EMPLOYEE
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Name | JANA SPARKS
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Credential |
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Telephone | 432-571-7061
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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