Provider Demographics
NPI:1528504065
Name:NSMD MEDICAL PLLC
Entity type:Organization
Organization Name:NSMD MEDICAL PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:BILLING
Authorized Official - Prefix:
Authorized Official - First Name:CANDACE
Authorized Official - Middle Name:D
Authorized Official - Last Name:WYNNE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:432-704-5663
Mailing Address - Street 1:PO BOX 4467
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79704-4467
Mailing Address - Country:US
Mailing Address - Phone:432-704-5663
Mailing Address - Fax:432-704-5660
Practice Address - Street 1:4400 N MIDLAND DR
Practice Address - Street 2:406B
Practice Address - City:MIDLAND
Practice Address - State:TX
Practice Address - Zip Code:79707-3385
Practice Address - Country:US
Practice Address - Phone:432-704-5663
Practice Address - Fax:432-704-5660
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-09
Last Update Date:2017-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP121037207Q00000X
TXAP128857207Q00000X
TXQ7356207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1144696436OtherNPI
TX1417224403OtherNPI
TX1811334105OtherNPI