Provider Demographics
NPI:1427131994
Name:DONLEY COUNTY MEDICAL GROUP PA
Entity type:Organization
Organization Name:DONLEY COUNTY MEDICAL GROUP PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LORI
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:HOWARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:806-874-3531
Mailing Address - Street 1:ONE MEDICAL CENTER DRIVE POD K
Mailing Address - Street 2:
Mailing Address - City:CLARENDON
Mailing Address - State:TX
Mailing Address - Zip Code:79226
Mailing Address - Country:US
Mailing Address - Phone:806-874-3531
Mailing Address - Fax:806-874-2244
Practice Address - Street 1:ONE MEDICAL CENTER DRIVE POD K
Practice Address - Street 2:
Practice Address - City:CLARENDON
Practice Address - State:TX
Practice Address - Zip Code:79226
Practice Address - Country:US
Practice Address - Phone:806-874-3531
Practice Address - Fax:806-874-2244
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-20
Last Update Date:2007-08-01
Deactivation Date:2007-07-17
Deactivation Code:
Reactivation Date:2007-08-01
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX121515OtherSUPERIOR
TX00854JMedicare Oscar/Certification