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Organization
CMG FAMILY CLINIC OF TEXARKANA
Active
Organization
CMG FAMILY CLINIC OF TEXARKANA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DONNA J MIKULECKY (CEO/PRESIDENT)
(713) 277-2208
Entity
Organization
Contact information
Practice address
401 EAST ST, TEXARKANA, AR 71854-6507
(870) 773-2177
(870) 773-2758
Mailing address
401 EAST ST, TEXARKANA, AR 71854-6507
(870) 773-2177
(870) 773-2758
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
081267903
—
TX
05
—
081267904
—
TX
05
—
127508002
—
AR
Enumeration date
04/25/2006
Last updated
06/26/2008
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