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General NPI Number Information
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NPI Number | 1538171616
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Entity Type | Organization
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Legal Business Name | MIDLAND COMPLETE FAMILY CARE AND ASSOCIATES
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Dates
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Enumeration Date | 08/13/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 4310 W ILLINOIS AVE STE 320
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City | MIDLAND
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State | TX
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Zip | 79703-5529
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Country | US
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Telephone | 432-617-5555
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Fax | 432-618-5555
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Provider Business Mailing Address
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Address Line | 4310 W ILLINOIS AVE STE 320
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City | MIDLAND
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State | TX
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Zip | 79703-5529
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Country | US
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Telephone | 432-617-5555
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Fax | 432-618-5555
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MICHAEL JOHN KACAL
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Credential | PA-C
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Telephone | 432-617-5555
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | PA03371
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License Number State | TX
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