# MOLINA MEDICAL MANAGEMENT GROUP.LTD

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Molina Medical Center
- **Organization subpart:** No

## Provider details

- **NPI number:** 1558323857
- **Authorized official:** MRS. BRANDI MICHELE GIBSON (ADMINISTRATOR)
- **Authorized official phone:** (972) 259-6900

## Contact information

- **Practice address:** 1901 W IRVING BLVD, SUITE 100, IRVING, TX 75061-6823
- **Practice address phone:** (972) 259-6900
- **Practice address fax:** (972) 254-5501
- **Mailing address:** 1901 W IRVING BLVD, STE 100, IRVING, TX 75061-6823
- **Mailing address phone:** (972) 259-6900
- **Mailing address fax:** (972) 254-5501

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208D00000X | General Practice Physician | — | TX | Yes |

## Other

- **Enumeration date:** 04/04/2006
- **Last updated:** 07/21/2022

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 0052EM | BCBS | TX |
| 05 | — | 092356702 | — | TX |
| 05 | — | 092357601 | — | TX |