Provider Demographics
NPI:1538171616
Name:MIDLAND COMPLETE FAMILY CARE AND ASSOCIATES
Entity type:Organization
Organization Name:MIDLAND COMPLETE FAMILY CARE AND ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:KACAL
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:432-617-5555
Mailing Address - Street 1:4310 W ILLINOIS AVE
Mailing Address - Street 2:STE 320
Mailing Address - City:MIDLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79703-5529
Mailing Address - Country:US
Mailing Address - Phone:432-617-5555
Mailing Address - Fax:432-618-5555
Practice Address - Street 1:4310 W ILLINOIS AVE
Practice Address - Street 2:STE 320
Practice Address - City:MIDLAND
Practice Address - State:TX
Practice Address - Zip Code:79703-5529
Practice Address - Country:US
Practice Address - Phone:432-617-5555
Practice Address - Fax:432-618-5555
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA03371363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX=========OtherEID