Family Medical Group of Texarkana
Organization Active NPI Family Medicine Physician · Texarkana, TX
NPI 1831233766 · NPPES record last updated Oct 22, 2007
Key facts
- NPI
- 1831233766
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Family Medicine Physician 207Q00000X
- Legal business name
- FAMILY MEDICAL GROUP OF TEXARKANA
- Practice address
- 2101 Galleria Oaks Dr
Texarkana, TX 75503-4625 - Phone
- (903) 791-9120
- Fax
- (903) 791-9132
- NPI assigned
- Feb 16, 2007
- Organization subpart
- No
Authorized official
- Name
- Michelle Grey
- Title
- Administrator
- Phone
- (903) 791-9120
Practitioners 17
-
Larry Steve Allen, FNP
-
Bryan D Bowen, MD
-
Cara P Cook, FNP
-
Ayvee Lavender, FNP-C
-
Craig David Mueller, FNP
-
John E Nix, MD
-
Charity A Noble, FNP
-
Patrick N Smith, RN, FNP
-
Shawn A Stussy, MD
-
Letha H Colquitt, FNP
-
Michael Chad Elliott, PA-C
-
David Droske, APN
-
Michael Thomas Crabtree, NURSE PRACTITIONER
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 45D1021708 | Family Medical Group of Texarkana, LLP | Compliance | Sep 26, 2026 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in TX
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040326000325 | TX | Part B Supplier - Clinic/Group Practice | 3870485626 |
Receives reassigned benefits from 15 practitioners Practice locations: Texarkana, TX; Wake Village, TX |
National Provider Directory
Locations
1340 S Constitution Ave
Ashdown, AR 71822
Phone (870) 888-2748
2602 Saint Michael Dr
Fl 4
Texarkana, TX 75503
Phone (903) 614-5370
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician |
207Q00000X | Yes |
Addresses
Primary practice location
2101 Galleria Oaks Dr
Texarkana, TX 75503-4625
Mailing address
2101 Galleria Oaks Dr
Texarkana, TX 75503-4625
Phone (903) 791-9120
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0066KV | Other | TX | TX BCBS |
| 9R053 | Other | AR | AR BCBS |
| DA3920 | Other | TX | RAILROAD MEDICARE |
Other providers in Texarkana, TX
- Eyemart Express, LTD.
- Nnamdi McAnthony Ezenyi
- Family & Sedation Dentistry of Texarkana
- Family Advocacy Center
- Family Care Home Health, Inc.
- Family Practice of Texarkana PLLC
- Fannin County Hospital Authority
- Fannin County Hospital Authority
- Fannin County Hospital Authority
- Jason Faris
All providers in Texarkana, TX · Family Medicine Physician in Texas
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 22, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.