Provider Demographics
NPI:1982935771
Name:HIGH PLAINS MEDICAL GROUP, LLC
Entity Type:Organization
Organization Name:HIGH PLAINS MEDICAL GROUP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:A
Authorized Official - Last Name:SAMES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:806-622-2725
Mailing Address - Street 1:PO BOX 10009
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79116-0009
Mailing Address - Country:US
Mailing Address - Phone:806-622-2725
Mailing Address - Fax:806-352-4887
Practice Address - Street 1:5211 W 9TH AVE
Practice Address - Street 2:SUITE 140
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79106-4149
Practice Address - Country:US
Practice Address - Phone:806-622-2725
Practice Address - Fax:806-352-4887
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-19
Last Update Date:2012-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
0A5948Medicare PIN