Provider Demographics
NPI:1346681061
Name:MIDLAND TEXAS ORTHOPEDIC GROUP INC
Entity Type:Organization
Organization Name:MIDLAND TEXAS ORTHOPEDIC GROUP INC
Other - Org Name:DBA WEST TEXAS ORTHOPEDICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CREDENTIALING
Authorized Official - Prefix:
Authorized Official - First Name:CANDACE
Authorized Official - Middle Name:
Authorized Official - Last Name:WYNNE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:432-686-6605
Mailing Address - Street 1:5615 DEAUVILLE BLVD
Mailing Address - Street 2:STE 220
Mailing Address - City:MIDLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79706
Mailing Address - Country:US
Mailing Address - Phone:432-686-0321
Mailing Address - Fax:432-686-0664
Practice Address - Street 1:5615 DEAUVILLE BLVD
Practice Address - Street 2:STE 220
Practice Address - City:MIDLAND
Practice Address - State:TX
Practice Address - Zip Code:79706
Practice Address - Country:US
Practice Address - Phone:432-686-0321
Practice Address - Fax:432-686-0664
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty