Provider Demographics
NPI:1306022520
Name:MAINLAND MULTI SPECIALTY GROUP PLLC
Entity type:Organization
Organization Name:MAINLAND MULTI SPECIALTY GROUP PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GROUP VP/AO
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:REBOK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-372-5004
Mailing Address - Street 1:2000 HEALTH PARK DR
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-4525
Mailing Address - Country:US
Mailing Address - Phone:615-373-7600
Mailing Address - Fax:866-346-1426
Practice Address - Street 1:6807 EMMETT F. LOWRY EXPRESSWAY
Practice Address - Street 2:SUITE 101
Practice Address - City:TEXAS CITY
Practice Address - State:TX
Practice Address - Zip Code:77591
Practice Address - Country:US
Practice Address - Phone:409-935-2930
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-17
Last Update Date:2020-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX194700401Medicaid
TX00Z182Medicare PIN