Organization
SENTINEL MEDICAL GROUP PLLC
Active
Other names
The Clinic at Greentree
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JACK KIM WILLIS JR. P.A (MANAGING MEMBER)
(432) 218-7862
Entity
Organization
Contact information
Practice address
4706 GREENTREE BLVD, MIDLAND, TX 79707-1610
(432) 218-7862
Mailing address
4706 GREENTREE BLVD, MIDLAND, TX 79707-1610
(432) 218-7862
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
E7559
TX
363AM0700X
Medical Physician Assistant
PA03268
TX
363AM0700X
Medical Physician Assistant
Primary
PA05950
TX
363LF0000X
Family Nurse Practitioner
623501
TX
Other
Enumeration date
08/06/2010
Last updated
09/28/2011
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