Provider Demographics
NPI:1194852400
Name:MIDLAND MINOR PA
Entity Type:Organization
Organization Name:MIDLAND MINOR PA
Other - Org Name:FIRST CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:TERRIER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:432-686-9708
Mailing Address - Street 1:2310 W OHIO AVE
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79701-5844
Mailing Address - Country:US
Mailing Address - Phone:432-686-9708
Mailing Address - Fax:432-686-0543
Practice Address - Street 1:2310 W OHIO AVE
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:TX
Practice Address - Zip Code:79701-5844
Practice Address - Country:US
Practice Address - Phone:432-686-9708
Practice Address - Fax:432-686-0543
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX889272OtherBCBS ID
TXG8562OtherDR KINZIE MEDICAL LIC
TXMDG8562OtherWORK COMP ID
TXG8562OtherDR KINZIE MEDICAL LIC
TXC17908Medicare UPIN