NPIMap

Organization Active NPI

Midland Mall FDC PA

  • Dentist
  • Midland, TX
National Provider Identifier
1366600504
Registry record updated May 23, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
0008481 Issued in TX
Legal business name
MIDLAND MALL FDC PA
Practice address
4511 N Midkiff Rd
Ste E15
Midland, TX 79705-3242
Phone
(432) 520-4867
Fax
(432) 694-7927
NPI assigned
May 23, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 23, 2008

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

Authorized official

Name
Lynn Armstrong
Title
Regional Manager
Phone
(505) 328-4867

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193400000X SINGLE SPECIALTY GROUP 122300000X 0008481 TX Primary

Addresses

Primary practice location

4511 N Midkiff Rd
Ste E15
Midland, TX 79705-3242

Mailing address

4511 N Midkiff Rd
Ste E15
Midland, TX 79705-3242
Phone (432) 520-4867

National Provider Directory

National Provider Directory

Locations

4511 N Midkiff Rd
Ste E15
Midland, TX 79705
Phone (432) 520-4867

Practitioners & affiliated clinicians

Practitioners 1

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": "1211500800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1211500800000",
    "number": "1366600504",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4511 N MIDKIFF RD",
            "address_2": "STE E15",
            "city": "MIDLAND",
            "state": "TX",
            "postal_code": "797053242",
            "telephone_number": "432-520-4867",
            "fax_number": "432-694-7927"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4511 N MIDKIFF RD",
            "address_2": "STE E15",
            "city": "MIDLAND",
            "state": "TX",
            "postal_code": "797053242",
            "telephone_number": "432-520-4867",
            "fax_number": "432-694-7927"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MIDLAND MALL FDC PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-05-23",
        "last_updated": "2008-05-23",
        "status": "A",
        "authorized_official_last_name": "ARMSTRONG",
        "authorized_official_first_name": "LYNN",
        "authorized_official_title_or_position": "REGIONAL MANAGER",
        "authorized_official_telephone_number": "505-328-4867"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "TX",
            "license": "0008481",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Midland, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 23, 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.