Provider Demographics
NPI:1679848253
Name:JUAN GARCIA MD PA
Entity Type:Organization
Organization Name:JUAN GARCIA MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:JUAN
Authorized Official - Middle Name:
Authorized Official - Last Name:GARCIA
Authorized Official - Suffix:
Authorized Official - Credentials:MD PA
Authorized Official - Phone:432-682-0652
Mailing Address - Street 1:PO BOX 4170
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79704-4170
Mailing Address - Country:US
Mailing Address - Phone:432-682-0652
Mailing Address - Fax:432-682-8081
Practice Address - Street 1:2401 W WALL ST
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:TX
Practice Address - Zip Code:79701-6315
Practice Address - Country:US
Practice Address - Phone:432-682-0652
Practice Address - Fax:432-682-8081
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-15
Last Update Date:2013-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF5914261QR0405X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXF5914OtherSTATES LICENSE
TXC15883Medicare UPIN