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NPI Code Detail

MEDICARE: MID-CITIES MEDICAL INSTITUTE, PLLC

MEDICARE: MID-CITIES MEDICAL INSTITUTE, PLLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1111NR0400XRehabilitation ChiropractorDC6911TX
2207LP2900XPain Medicine (Anesthesiology) PhysicianJ0365TX
3208D00000XGeneral Practice PhysicianMCH-7354TX

General Provider Information

NPI Number : 1427296912
Entity Type Code : Organization
Provider Name (Legal Business Name) : MID-CITIES MEDICAL INSTITUTE, PLLC
Provider Business Mailing Address
First Line : PO BOX 1583
Second Line :
City : COLLEYVILLE
State : TX
Zip : 76034-1583
Country : US
Telephone Number : 817-498-7400
Fax Number : 817-503-9967
Provider Business Practice Location Address
First Line : 8208 BEDFORD EULESS RD
Second Line :
City : NORTH RICHLAND HILLS
State : TX
Zip : 76180-7214
Country : US
Telephone Number : 817-498-7400
Fax Number : 817-503-9967
Authorized Official
Title or Position : PRESIDENT
Name : DR. CHARLES E WILLIS II
Credential : M.D.
Telephone Number : 817-498-7400
Provider Enumeration Date : 01/22/2009
Last Update Date : 07/27/2009

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Directions to “MID-CITIES MEDICAL INSTITUTE, PLLC ” Practice Location

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