| Mid Level Health Provider Services Llc | |
|
398 Lcr 398 Apt B Groesbeck TX 76642-2797 | |
| (254) 640-9581 | |
| Not Available |
| Full Name | Mid Level Health Provider Services Llc |
|---|---|
| Speciality | Family Medicine |
| Location | 398 Lcr 398 Apt B, Groesbeck, Texas |
| Authorized Official Name and Position | Barbara Dodson (PRESIDENT) |
| Authorized Official Contact | 2546409581 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Mid Level Health Provider Services Llc 398 Lcr 398 Apt B Groesbeck TX 76642-2797 Ph: (254) 640-9581 | Mid Level Health Provider Services Llc 398 Lcr 398 Apt B Groesbeck TX 76642-2797 Ph: (254) 640-9581 |
| NPI Number | 1568712180 |
|---|---|
| Provider Enumeration Date | 09/11/2012 |
| Last Update Date | 09/27/2012 |
| Medicare PECOS PAC ID | 3577712751 |
|---|---|
| Medicare Enrollment ID | O20121003000440 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1568712180 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 583313 (Texas) | Primary |
| Provider Name | Barbara J Dodson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1730224296 PECOS PAC ID: 3274625199 Enrollment ID: I20070823000572 |
| Provider Name | Michael L Capps |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1962787614 PECOS PAC ID: 1153648894 Enrollment ID: I20150318000690 |
| Provider Name | Latarsha Waltronia Edwards |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1376073072 PECOS PAC ID: 9032474283 Enrollment ID: I20180517002220 |
| Provider Name | Sara Chiglo |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1346934866 PECOS PAC ID: 1759740541 Enrollment ID: I20230712000029 |
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