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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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