Provider Demographics
NPI:1043358757
Name:HIGH PLAINS FAMILY MEDICINE PA
Entity Type:Organization
Organization Name:HIGH PLAINS FAMILY MEDICINE PA
Other - Org Name:BORGER MEDICAL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT / PROVIDER
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:COLQUITT
Authorized Official - Last Name:NASH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:806-274-2986
Mailing Address - Street 1:104 N BRYAN ST
Mailing Address - Street 2:
Mailing Address - City:BORGER
Mailing Address - State:TX
Mailing Address - Zip Code:79007-4010
Mailing Address - Country:US
Mailing Address - Phone:806-274-2986
Mailing Address - Fax:806-274-9176
Practice Address - Street 1:104 N BRYAN ST
Practice Address - Street 2:
Practice Address - City:BORGER
Practice Address - State:TX
Practice Address - Zip Code:79007-4010
Practice Address - Country:US
Practice Address - Phone:806-274-2986
Practice Address - Fax:806-274-9176
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-02
Last Update Date:2012-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX673821261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX172322302Medicaid
TX673821Medicare ID - Type Unspecified