=====================================================
General NPI Number Information
=====================================================
NPI Number | 1356374854
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | FIRST PHYSICIANS, PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/08/2006
-----------------------------------------------------
Last Update Date | 04/25/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4222 WENDOVER AVE STE 600
-----------------------------------------------------
City | ODESSA
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 79762-5983
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 432-552-5656
-----------------------------------------------------
Fax | 866-730-6998
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4222 WENDOVER AVE SUITE 600
-----------------------------------------------------
City | ODESSA
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 79762-5945
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 432-552-5656
-----------------------------------------------------
Fax | 432-552-0992
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MICHAEL VISE SHELTON
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 432-552-5656
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------