Organization
MEDICAL CENTER MEDICAL GROUP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MIKE POTTER (CEO)
(903) 798-7365
Entity
Organization
Contact information
Practice address
1000 PINE ST, TEXARKANA, TX 75501-5100
(903) 798-7365
Mailing address
1000 PINE ST, TEXARKANA, TX 75501-5100
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
—
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
163118602
—
TX
Enumeration date
05/02/2006
Last updated
07/21/2022
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