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Organization
MOLINA MEDICAL MANAGEMENT GROUP.LTD
Active
Organization
MOLINA MEDICAL MANAGEMENT GROUP.LTD
Active
Other names
Molina Medical Center
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. BRANDI MICHELE GIBSON (ADMINISTRATOR)
(972) 259-6900
Entity
Organization
Contact information
Practice address
1901 W IRVING BLVD, SUITE 100, IRVING, TX 75061-6823
(972) 259-6900
(972) 254-5501
Mailing address
1901 W IRVING BLVD, STE 100, IRVING, TX 75061-6823
(972) 259-6900
(972) 254-5501
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
—
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0052EM
BCBS
TX
05
—
092356702
—
TX
05
—
092357601
—
TX
Enumeration date
04/04/2006
Last updated
07/21/2022
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