NPIMap

Organization Active NPI

Midland Community Healthcare Services

  • Federally Qualified Health Center (FQHC)
  • Midland, TX
National Provider Identifier
1609975556
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
4214 Andrews Hwy Ste 310
Midland, TX 79703-4822
Phone
(432) 697-4747
Fax
(432) 699-3813
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 2

Specialty (taxonomy)CodeLicenseStatePrimary
Obstetrics & Gynecology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207V00000X
Federally Qualified Health Center (FQHC) 261QF0400X TX Primary

Addresses

Primary practice location

4214 Andrews Hwy Ste 310
Midland, TX 79703-4822

Mailing address

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

Other identifiers 6

IdentifierTypeStateIssuer
830358635OtherTXCOMM INSURANCE
165581306MedicaidTX
169875501MedicaidTX
0090KVOtherTXBLUE CROSS BLUE SHIELD
165581305MedicaidTX
165581301MedicaidTX

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050328000906 TX Part A Provider - Federally Qualified Health Center (FQHC) 0345230975 Practice locations: Midland, TX

Federally qualified health center certification: CCN 671817

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 – corporation
Organization structure
CorporationNon-profit
Incorporated
May 23, 2003 in TX
Enrollment address
4214 Andrews Hwy
Ste 310
Midland, TX 79703-4822

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
45D1023658Midland Community Healthcare Services4214 Andrews Hwy Suite 310, Midland, TX 79703Provider-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

2500 Delano Ave
Midland, TX 79701
Phone (432) 697-4747

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 OfficerBoard Member Jan 1, 2014
Virgina Davis Individual Corporate DirectorBoard Member Mar 28, 2005
Jake Flader Individual Corporate OfficerBoard Member Jan 1, 2014
Michael Austin Individual Corporate DirectorCeo Mar 17, 2009
W-2 Managing EmployeeCeo Mar 17, 2009

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": "1609975556",
    "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": "4214 ANDREWS HWY STE 310",
            "city": "MIDLAND",
            "state": "TX",
            "postal_code": "797034822",
            "telephone_number": "432-697-4747",
            "fax_number": "432-699-3813"
        }
    ],
    "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": "207V00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Obstetrics & Gynecology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "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": "COMM INSURANCE",
            "identifier": "830358635",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "165581306",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "169875501",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "0090KV",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "165581305",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "165581301",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Midland, TX

Sources for this page

Verify at the official NPI Registry.