Provider Demographics
NPI:1568712180
Name:MID LEVEL HEALTH PROVIDER SERVICES LLC
Entity Type:Organization
Organization Name:MID LEVEL HEALTH PROVIDER SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:
Authorized Official - Last Name:DODSON
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:254-640-9581
Mailing Address - Street 1:398 LCR 398 APT B
Mailing Address - Street 2:
Mailing Address - City:GROESBECK
Mailing Address - State:TX
Mailing Address - Zip Code:76642-2797
Mailing Address - Country:US
Mailing Address - Phone:254-640-9581
Mailing Address - Fax:
Practice Address - Street 1:398 LCR 398 APT B
Practice Address - Street 2:
Practice Address - City:GROESBECK
Practice Address - State:TX
Practice Address - Zip Code:76642-2797
Practice Address - Country:US
Practice Address - Phone:254-640-9581
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-11
Last Update Date:2012-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX583313207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty