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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