Provider Demographics
NPI:1710165485
Name:MAINLAND INFECTIOUS DISEASE ASSOCIATES, P.A.
Entity Type:Organization
Organization Name:MAINLAND INFECTIOUS DISEASE ASSOCIATES, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:WARNER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:409-370-1087
Mailing Address - Street 1:PO BOX 57579
Mailing Address - Street 2:
Mailing Address - City:WEBSTER
Mailing Address - State:TX
Mailing Address - Zip Code:77598-7579
Mailing Address - Country:US
Mailing Address - Phone:409-370-1087
Mailing Address - Fax:409-419-1108
Practice Address - Street 1:1125 HIGHWAY 3 N STE 100A
Practice Address - Street 2:
Practice Address - City:TEXAS CITY
Practice Address - State:TX
Practice Address - Zip Code:77591-4047
Practice Address - Country:US
Practice Address - Phone:409-539-6278
Practice Address - Fax:409-419-1108
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-05
Last Update Date:2011-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ9932207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXCH4054OtherPALMETTO GBA
TX209594501Medicaid
TX209594501Medicaid