Provider Demographics
NPI:1346323979
Name:MEDICAL DOCTOR ASSOC, INC.
Entity Type:Organization
Organization Name:MEDICAL DOCTOR ASSOC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:STAFFING CONSULTANT
Authorized Official - Prefix:MS
Authorized Official - First Name:JONI
Authorized Official - Middle Name:
Authorized Official - Last Name:SCRIBNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:800-809-0436
Mailing Address - Street 1:PO BOX 1936
Mailing Address - Street 2:
Mailing Address - City:MT PLEASANT
Mailing Address - State:TX
Mailing Address - Zip Code:75456-1936
Mailing Address - Country:US
Mailing Address - Phone:903-572-4817
Mailing Address - Fax:
Practice Address - Street 1:1764 FARM ROAD 899
Practice Address - Street 2:
Practice Address - City:MT PLEASANT
Practice Address - State:TX
Practice Address - Zip Code:75455-9159
Practice Address - Country:US
Practice Address - Phone:903-572-4817
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXD1041282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP000J1331Medicaid
TXP000J1331Medicaid
TXB26265Medicare UPIN