NPIMap

Organization Active NPI

CMG Family Clinic of Texarkana

  • Family Medicine Physician
  • Texarkana, AR
National Provider Identifier
1255397469
Registry record updated Jun 26, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
CMG FAMILY CLINIC OF TEXARKANA
Practice address
401 East St
Texarkana, AR 71854-6507
Phone
(870) 773-2177
Fax
(870) 773-2758
NPI assigned
Apr 25, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 26, 2008

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

Authorized official

Name
Donna J Mikulecky
Title
Ceo/President
Phone
(713) 277-2208

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X Primary

Addresses

Primary practice location

401 East St
Texarkana, AR 71854-6507

Mailing address

401 East St
Texarkana, AR 71854-6507
Phone (870) 773-2177

Other identifiers 3

IdentifierTypeStateIssuer
081267903MedicaidTX
127508002MedicaidAR
081267904MedicaidTX

National Provider Directory

National Provider Directory
Tax ID family
Christus Medical GRP32 organizations share this tax ID, including this one

Other organizations with this tax ID 31

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

View all 31

Locations

401 East St
Texarkana, AR 71854
Phone (870) 216-0829

Practitioners & affiliated clinicians

Practitioners 2

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": "1145923200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1214438400000",
    "number": "1255397469",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "401 EAST ST",
            "city": "TEXARKANA",
            "state": "AR",
            "postal_code": "718546507",
            "telephone_number": "870-773-2177",
            "fax_number": "870-773-2758"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "401 EAST ST",
            "city": "TEXARKANA",
            "state": "AR",
            "postal_code": "718546507",
            "telephone_number": "870-773-2177",
            "fax_number": "870-773-2758"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CMG FAMILY CLINIC OF TEXARKANA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-04-25",
        "last_updated": "2008-06-26",
        "status": "A",
        "authorized_official_last_name": "MIKULECKY",
        "authorized_official_first_name": "DONNA",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "CEO/PRESIDENT",
        "authorized_official_telephone_number": "713-277-2208"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "081267903",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "127508002",
            "state": "AR"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "081267904",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Texarkana, AR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 26, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.