Organization Active NPI

Molina Medical Management Group.LTD

Doing business as Molina Medical Center

  • General Practice Physician
  • Irving, TX
National Provider Identifier
1558323857
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice PhysicianTaxonomy code 208D00000X
Legal business name
MOLINA MEDICAL MANAGEMENT GROUP.LTD
Doing business as
Molina Medical Center
Practice address
1901 W Irving Blvd
Suite 100
Irving, TX 75061-6823
Phone
(972) 259-6900
Fax
(972) 254-5501
NPI assigned
Apr 4, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

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

Authorized official

Name
Mrs. Brandi Michele Gibson
Title
Administrator
Phone
(972) 259-6900

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208D00000X TX Primary

Addresses

Primary practice location

1901 W Irving Blvd
Suite 100
Irving, TX 75061-6823

Mailing address

1901 W Irving Blvd
Ste 100
Irving, TX 75061-6823
Phone (972) 259-6900

Other identifiers 3

IdentifierTypeStateIssuer
0052EMOtherTXBCBS
092356702MedicaidTX
092357601MedicaidTX

Other names 1

  • Molina Medical Center Doing business as

National Provider Directory

National Provider Directory

Locations

1901 W Irving Blvd
Ste 100
Irving, TX 75061
Phone (972) 259-6900

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": "1144108800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1558323857",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1901 W IRVING BLVD",
            "address_2": "STE 100",
            "city": "IRVING",
            "state": "TX",
            "postal_code": "750616823",
            "telephone_number": "972-259-6900",
            "fax_number": "972-254-5501"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1901 W IRVING BLVD",
            "address_2": "SUITE 100",
            "city": "IRVING",
            "state": "TX",
            "postal_code": "750616823",
            "telephone_number": "972-259-6900",
            "fax_number": "972-254-5501"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MOLINA MEDICAL MANAGEMENT GROUP.LTD",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-04-04",
        "last_updated": "2022-07-21",
        "status": "A",
        "authorized_official_last_name": "GIBSON",
        "authorized_official_first_name": "BRANDI",
        "authorized_official_middle_name": "MICHELE",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "972-259-6900",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "General Practice",
            "state": "TX",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "0052EM",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "092356702",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "092357601",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Molina Medical Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Irving, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; 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.