Provider Demographics
NPI:1699959569
Name:CITY OF MIDLAND
Entity type:Organization
Organization Name:CITY OF MIDLAND
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HEALTH AUTHORITY
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:HUMPHREYS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:432-681-7613
Mailing Address - Street 1:PO BOX 4905
Mailing Address - Street 2:3303 W ILLINOIS SP 22
Mailing Address - City:MIDLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79703
Mailing Address - Country:US
Mailing Address - Phone:432-681-7613
Mailing Address - Fax:432-681-7634
Practice Address - Street 1:3303 W ILLINOIS
Practice Address - Street 2:SP 22
Practice Address - City:MIDLAND
Practice Address - State:TX
Practice Address - Zip Code:79703
Practice Address - Country:US
Practice Address - Phone:432-681-7613
Practice Address - Fax:432-681-7634
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-27
Last Update Date:2010-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX092166001Medicaid
TXPH0396Medicare PIN