Provider Demographics
NPI:1578191292
Name:ADA ADULT AND CHILDREN FAMILY CLINIC LLC
Entity Type:Organization
Organization Name:ADA ADULT AND CHILDREN FAMILY CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:OLANREWAJU
Authorized Official - Middle Name:SAMUEL
Authorized Official - Last Name:AYILEKA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:432-400-3066
Mailing Address - Street 1:PO BOX 4534
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79704-4534
Mailing Address - Country:US
Mailing Address - Phone:432-400-3066
Mailing Address - Fax:432-400-0871
Practice Address - Street 1:3416 W WALL ST
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:TX
Practice Address - Zip Code:79701-6710
Practice Address - Country:US
Practice Address - Phone:432-400-3066
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-29
Last Update Date:2024-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty