Provider Demographics
NPI:1700990173
Name:MIAP, PC
Entity Type:Organization
Organization Name:MIAP, PC
Other - Org Name:SEAGOVILLE FAMILY MEDICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICAL ASSISTANT
Authorized Official - Prefix:MR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:L
Authorized Official - Last Name:GELBER
Authorized Official - Suffix:
Authorized Official - Credentials:PA
Authorized Official - Phone:972-287-7474
Mailing Address - Street 1:116 HALL RD
Mailing Address - Street 2:
Mailing Address - City:SEAGOVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75159
Mailing Address - Country:US
Mailing Address - Phone:972-287-7474
Mailing Address - Fax:972-287-7464
Practice Address - Street 1:116 HALL RD
Practice Address - Street 2:
Practice Address - City:SEAGOVILLE
Practice Address - State:TX
Practice Address - Zip Code:75159-2916
Practice Address - Country:US
Practice Address - Phone:972-287-7474
Practice Address - Fax:972-287-7464
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-19
Last Update Date:2008-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX45D1024097OtherCLIA
TX178739202Medicaid
TX178739201Medicaid
TXDE6386OtherRAILROAD MEDICARE
TX0072NHOtherBLUECROSSBLUESHIELD GROUP
TX178739201Medicaid