Provider Demographics
NPI:1770794752
Name:MARK L. GINNINGS MD PA
Entity type:Organization
Organization Name:MARK L. GINNINGS MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:GINNINGS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:940-387-7441
Mailing Address - Street 1:3537 S INTERSTATE 35 E
Mailing Address - Street 2:SUITE 313
Mailing Address - City:DENTON
Mailing Address - State:TX
Mailing Address - Zip Code:76210-6800
Mailing Address - Country:US
Mailing Address - Phone:940-387-7441
Mailing Address - Fax:940-387-2922
Practice Address - Street 1:3537 S INTERSTATE 35 E
Practice Address - Street 2:SUITE 313
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76210-6800
Practice Address - Country:US
Practice Address - Phone:940-387-7441
Practice Address - Fax:940-387-2922
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH2403207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00512JMedicare ID - Type Unspecified
TXD87439Medicare UPIN