Provider Demographics
NPI:1982603999
Name:MIDCOUNTY FAMILY PHYSICIANS ASSOCIATES, LLP
Entity type:Organization
Organization Name:MIDCOUNTY FAMILY PHYSICIANS ASSOCIATES, LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:K
Authorized Official - Last Name:CRAIG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:409-722-3416
Mailing Address - Street 1:3820 HIGHWAY 365
Mailing Address - Street 2:STE 100
Mailing Address - City:PORT ARTHUR
Mailing Address - State:TX
Mailing Address - Zip Code:77642-7543
Mailing Address - Country:US
Mailing Address - Phone:409-722-3416
Mailing Address - Fax:409-729-5656
Practice Address - Street 1:3820 HIGHWAY 365
Practice Address - Street 2:STE 100
Practice Address - City:PORT ARTHUR
Practice Address - State:TX
Practice Address - Zip Code:77642-7543
Practice Address - Country:US
Practice Address - Phone:409-722-3416
Practice Address - Fax:409-729-5656
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-20
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
00235ROtherBCBS OF TX PROVIDER #
00235ROtherBCBS OF TX PROVIDER #