Provider Demographics
NPI:1295793214
Name:A & D MEDICAL CENTER, LLC
Entity type:Organization
Organization Name:A & D MEDICAL CENTER, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:DAVISON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:432-943-7537
Mailing Address - Street 1:405 S. MAIN STREET
Mailing Address - Street 2:STE 100
Mailing Address - City:MONAHANS
Mailing Address - State:TX
Mailing Address - Zip Code:79756-4506
Mailing Address - Country:US
Mailing Address - Phone:432-943-7537
Mailing Address - Fax:432-943-4767
Practice Address - Street 1:405 S. MAIN STREET
Practice Address - Street 2:STE 100
Practice Address - City:MONAHANS
Practice Address - State:TX
Practice Address - Zip Code:79756-4506
Practice Address - Country:US
Practice Address - Phone:432-943-7537
Practice Address - Fax:432-943-4767
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-01
Last Update Date:2013-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX063441201Medicaid
TX091921901Medicaid
TX091921902Medicaid
TX091921901Medicaid
TX091921902Medicaid