Provider Demographics
NPI:1629667845
Name:MIDTOWN MEDICAL AND WELLNESS CENTER
Entity Type:Organization
Organization Name:MIDTOWN MEDICAL AND WELLNESS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INSURANCE/BILLING SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:AMBER
Authorized Official - Middle Name:
Authorized Official - Last Name:VAUGHN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:806-379-8004
Mailing Address - Street 1:1005 S JEFFERSON ST
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79101-3231
Mailing Address - Country:US
Mailing Address - Phone:806-379-8004
Mailing Address - Fax:806-379-7639
Practice Address - Street 1:1005 S JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79101-3231
Practice Address - Country:US
Practice Address - Phone:806-379-8004
Practice Address - Fax:806-379-7639
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-12
Last Update Date:2021-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty