NPIMap

Organization Active NPI

Family Medical Group of Texarkana

  • Family Medicine Physician
  • Texarkana, TX
National Provider Identifier
1831233766
Registry record updated Oct 22, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 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
Last updated
Oct 22, 2007By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 22, 2007

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

Authorized official

Name
Michelle Grey
Title
Administrator
Phone
(903) 791-9120

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X Primary

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 3

IdentifierTypeStateIssuer
9R053OtherARAR BCBS
DA3920OtherTXRAILROAD MEDICARE
0066KVOtherTXTX BCBS

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040326000325 TX Part B Supplier - Clinic/Group Practice 3870485626 Receives reassigned benefits from 15 practitioners
Practice locations: Texarkana, TX; Wake Village, TX

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
45D1021708Family Medical Group of Texarkana, LLP2101 Galleria Oaks, Texarkana, TX 75503ComplianceSep 26, 2026

National Provider Directory

National Provider Directory

Locations

2602 Saint Michael Dr
Fl 4
Texarkana, TX 75503
Phone (903) 614-5370

5212 W 7th St
Wake Village, TX 75501
Phone (903) 791-9120

Practitioners & affiliated clinicians

Practitioners 17

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.

View all 17

NPI Registry JSON

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

{
    "created_epoch": "1171584000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1193011200000",
    "number": "1831233766",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2101 GALLERIA OAKS DR",
            "city": "TEXARKANA",
            "state": "TX",
            "postal_code": "755034625",
            "telephone_number": "903-791-9120",
            "fax_number": "903-791-9132"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2101 GALLERIA OAKS DR",
            "city": "TEXARKANA",
            "state": "TX",
            "postal_code": "755034625",
            "telephone_number": "903-791-9120",
            "fax_number": "903-791-9132"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAMILY MEDICAL GROUP OF TEXARKANA",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-16",
        "last_updated": "2007-10-22",
        "status": "A",
        "authorized_official_last_name": "GREY",
        "authorized_official_first_name": "MICHELLE",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "903-791-9120"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AR BCBS",
            "identifier": "9R053",
            "state": "AR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "DA3920",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TX BCBS",
            "identifier": "0066KV",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Texarkana, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 22, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.