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General NPI Number Information
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NPI Number | 1568712180
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Entity Type | Organization
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Legal Business Name | MID LEVEL HEALTH PROVIDER SERVICES LLC
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Dates
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Enumeration Date | 09/11/2012
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Last Update Date | 09/27/2012
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Provider Practice Location Address
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Address Line | 398 LCR 398 APT B
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City | GROESBECK
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State | TX
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Zip | 76642-2797
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Country | US
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Telephone | 254-640-9581
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Fax |
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Provider Business Mailing Address
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Address Line | 398 LCR 398 APT B
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City | GROESBECK
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State | TX
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Zip | 76642-2797
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Country | US
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Telephone | 254-640-9581
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | BARBARA DODSON
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Credential | FNP
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Telephone | 254-640-9581
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 583313
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License Number State | TX
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