NPIMap

Organization Active NPI

Midland Community Healthcare Services

  • Federally Qualified Health Center (FQHC)
  • Midland, TX
National Provider Identifier
1013016906
Registry record updated Jun 3, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
MIDLAND COMMUNITY HEALTHCARE SERVICES
Practice address
400 Rosalind Redfern Grover Pkwy
3Rd Floor
Midland, TX 79701-5846
Phone
(432) 681-3100
Fax
(432) 681-3108
NPI assigned
Sep 21, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 3, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Michael Austin, PHD
Title
Ceo
Phone
(432) 570-0238

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X TX Primary

Addresses

Primary practice location

400 Rosalind Redfern Grover Pkwy
3Rd Floor
Midland, TX 79701-5846

Mailing address

PO Box 5576
Midland, TX 79704-5576
Phone (432) 570-0238

Other identifiers 3

IdentifierTypeStateIssuer
0090KVOtherTXBLUE CROSS BLUE SHEILD
165581307MedicaidTX
165581305MedicaidTX

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050404000764 TX Part A Provider - Federally Qualified Health Center (FQHC) 0345230975 Practice locations: Midland, TX

Federally qualified health center certification: CCN 671815

Legal name
MIDLAND COMMUNITY HEALTHCARE SERVICES
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Apr 7, 2005
Last certification
Apr 7, 2005
Ownership / control type
For profit – partnership
Organization structure
CorporationNon-profit
Incorporated
May 23, 2003 in TX
Enrollment address
400 Rosalind Redfern Grover Pkwy 3
Midland, TX 79701-5846

Other NPIs with the same Medicare PAC ID 3

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
45D1023654Midland Community Healthcare Services400 Rosalind Redfern Grover Parkway 3Rd Floor, Midland, TX 79701Provider-performed microscopyMar 21, 2028

National Provider Directory

National Provider Directory
Tax ID family
Midland Comm Hlthcare SVCS6 organizations share this tax ID, including this one

Other organizations with this tax ID 5

Organizations that report the same tax identification number in the National Provider Directory.

Locations

400 Rosalind Redfern Grover Pkwy
Fl 3
Midland, TX 79701
Phone (432) 681-3100

801 E Florida Ave
Ste 101
Midland, TX 79701

4214 Andrews Hwy
Ste 310
Midland, TX 79703
Phone (432) 697-4747

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/EJEICD

Ownership & related parties

All disclosed owners & managing parties 4

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Lydia Frescaz Individual Corporate Officer Jan 1, 2014
Virgina Davis Individual Corporate Director Apr 4, 2005
Jake Flader Individual Corporate Officer Jan 1, 2014
Michael Austin Individual W-2 Managing EmployeeCeo Mar 17, 2009

Practitioners & affiliated clinicians

Practitioners 11

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1158796800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1622678400000",
    "number": "1013016906",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 5576",
            "city": "MIDLAND",
            "state": "TX",
            "postal_code": "797045576",
            "telephone_number": "432-570-0238",
            "fax_number": "432-699-3815"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "400 ROSALIND REDFERN GROVER PKWY",
            "address_2": "3RD FLOOR",
            "city": "MIDLAND",
            "state": "TX",
            "postal_code": "797015846",
            "telephone_number": "432-681-3100",
            "fax_number": "432-681-3108"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MIDLAND COMMUNITY HEALTHCARE SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-21",
        "last_updated": "2021-06-03",
        "certification_date": "2021-06-03",
        "status": "A",
        "authorized_official_last_name": "AUSTIN",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "432-570-0238",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "PHD"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "TX",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHEILD",
            "identifier": "0090KV",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "165581307",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "165581305",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Midland, TX

Sources for this page

Verify at the official NPI Registry.