Provider Demographics
NPI:1013016906
Name:MIDLAND COMMUNITY HEALTHCARE SERVICES
Entity Type:Organization
Organization Name:MIDLAND COMMUNITY HEALTHCARE SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:AUSTIN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:432-570-0238
Mailing Address - Street 1:PO BOX 5576
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79704-5576
Mailing Address - Country:US
Mailing Address - Phone:432-570-0238
Mailing Address - Fax:432-699-3815
Practice Address - Street 1:400 ROSALIND REDFERN GROVER PKWY
Practice Address - Street 2:3RD FLOOR
Practice Address - City:MIDLAND
Practice Address - State:TX
Practice Address - Zip Code:79701-5846
Practice Address - Country:US
Practice Address - Phone:432-681-3100
Practice Address - Fax:432-681-3108
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-21
Last Update Date:2021-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX261QF0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0090KVOtherBLUE CROSS BLUE SHEILD
TX165581307Medicaid
TX165581305Medicaid
TX=========OtherCOMM INSURANCE
TX671815Medicare ID - Type UnspecifiedFQHC MEDICARE