NPIMap

Organization Active NPI

Mid Coast Medical Center-Central

Doing business as Mid Coast Wellcare Kingsland

  • Family Medicine Physician
  • Kingsland, TX
National Provider Identifier
1427635804
Registry record updated Dec 26, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
MID COAST MEDICAL CENTER-CENTRAL
Doing business as
Mid Coast Wellcare Kingsland
Practice address
308 Ranch Road 2900
Kingsland, TX 78639-6063
Phone
(979) 543-5510
NPI assigned
Mar 24, 2021
Last updated
Dec 26, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 26, 2024

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

Authorized official

Name
David H Mak
Title
Chief Financial Officer
Phone
(713) 569-7370

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X Primary
Rural Health Clinic/Center 261QR1300X

Addresses

Primary practice location

308 Ranch Road 2900
Kingsland, TX 78639-6063

Mailing address

305 Sandy Corner Rd
El Campo, TX 77437-9535
Phone (979) 543-5510

Other names 1

  • MID COAST WELLCARE KINGSLAND Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20110603000276 TX Part B Supplier - Clinic/Group Practice 4082803614 Receives reassigned benefits from 6 practitioners
3 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Llano, TX
O20140813001385 TX Part B Supplier - Clinic/Group Practice 6406021765 Receives reassigned benefits from 38 practitioners
23 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Wharton, TX; Palacios, TX; Mason, TX; Louise, TX; Ganado, TX; El Campo, TX; Boling, TX; Blessing, TX…

Other NPIs on the same Medicare enrollment 24

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

View all 24

National Provider Directory

National Provider Directory

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Locations

308 Ranch Road 2900
Kingsland, TX 78639
Phone (325) 248-6600

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1616544000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1735171200000",
    "number": "1427635804",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "305 SANDY CORNER RD",
            "city": "EL CAMPO",
            "state": "TX",
            "postal_code": "774379535",
            "telephone_number": "979-543-5510"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "308 RANCH ROAD 2900",
            "city": "KINGSLAND",
            "state": "TX",
            "postal_code": "786396063",
            "telephone_number": "979-543-5510"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MID COAST MEDICAL CENTER-CENTRAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-03-24",
        "last_updated": "2024-12-26",
        "certification_date": "2024-12-26",
        "status": "A",
        "authorized_official_last_name": "MAK",
        "authorized_official_first_name": "DAVID",
        "authorized_official_middle_name": "H",
        "authorized_official_title_or_position": "CHIEF FINANCIAL OFFICER",
        "authorized_official_telephone_number": "713-569-7370"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "MID COAST WELLCARE KINGSLAND",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Kingsland, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 26, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.