Provider Demographics
NPI:1548312465
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:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARIO
Authorized Official - Middle Name:MIGUEL
Authorized Official - Last Name:GROSS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:431-617-5555
Mailing Address - Street 1:4400 N MIDLAND DR
Mailing Address - Street 2:STE 506A
Mailing Address - City:MIDLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79707-3385
Mailing Address - Country:US
Mailing Address - Phone:432-617-5555
Mailing Address - Fax:432-618-5555
Practice Address - Street 1:4400 N MIDLAND DR
Practice Address - Street 2:STE 506A
Practice Address - City:MIDLAND
Practice Address - State:TX
Practice Address - Zip Code:79707-3385
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:2007-01-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK6596207V00000X
TXPA03371363AM0700X
TXPA03268363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
Not Answered363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0027KNOtherBCBS
TXDB9249OtherRAILROAD MEDICARE
TXDB9249OtherRAILROAD MEDICARE
TX=========OtherTAX ID