Provider Demographics
NPI:1518952464
Name:MIDLAND PEDIATRIC ASSOCIATION, PLLC
Entity Type:Organization
Organization Name:MIDLAND PEDIATRIC ASSOCIATION, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OM
Authorized Official - Prefix:
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:
Authorized Official - Last Name:BENSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:432-620-8687
Mailing Address - Street 1:4214 MAMIES CIR
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79707-2123
Mailing Address - Country:US
Mailing Address - Phone:432-620-8687
Mailing Address - Fax:432-682-1831
Practice Address - Street 1:4214 MAMIES CIR
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:TX
Practice Address - Zip Code:79707-2123
Practice Address - Country:US
Practice Address - Phone:432-620-8687
Practice Address - Fax:432-682-1831
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-16
Last Update Date:2023-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX095078402Medicaid