Provider Demographics
NPI:1114039419
Name:MIDLAND FAMILY MEDICAL SERVICES
Entity Type:Organization
Organization Name:MIDLAND FAMILY MEDICAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JUBEL
Authorized Official - Middle Name:KEITH
Authorized Official - Last Name:REED
Authorized Official - Suffix:
Authorized Official - Credentials:PAC
Authorized Official - Phone:432-684-4488
Mailing Address - Street 1:1300 W WALL ST
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79701
Mailing Address - Country:US
Mailing Address - Phone:432-684-4488
Mailing Address - Fax:432-684-6644
Practice Address - Street 1:1300 W WALL ST
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:TX
Practice Address - Zip Code:79701
Practice Address - Country:US
Practice Address - Phone:432-684-4488
Practice Address - Fax:432-684-6644
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA03316363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
8G2569Medicare ID - Type Unspecified
P82484Medicare UPIN