Provider Demographics
NPI:1780835025
Name:MEDICAL AND HEALTH ALLIANCE
Entity Type:Organization
Organization Name:MEDICAL AND HEALTH ALLIANCE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:EDGAR
Authorized Official - Middle Name:A
Authorized Official - Last Name:LOCKETT
Authorized Official - Suffix:
Authorized Official - Credentials:M D
Authorized Official - Phone:806-351-1560
Mailing Address - Street 1:PO BOX 50360
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79159-0360
Mailing Address - Country:US
Mailing Address - Phone:806-351-1560
Mailing Address - Fax:806-351-0343
Practice Address - Street 1:6819 PLUM CREEK DR
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79124-1602
Practice Address - Country:US
Practice Address - Phone:806-351-1560
Practice Address - Fax:806-351-0343
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-06
Last Update Date:2010-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH4020207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
0A0259Medicare PIN