Organization
FAMILY MEDICAL GROUP OF TEXARKANA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MICHELLE GREY (ADMINISTRATOR)
(903) 791-9120
Entity
Organization
Contact information
Practice address
2101 GALLERIA OAKS DR, TEXARKANA, TX 75503-4625
(903) 791-9120
(903) 791-9132
Mailing address
2101 GALLERIA OAKS DR, TEXARKANA, TX 75503-4625
(903) 791-9120
(903) 791-9132
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0066KV
TX BCBS
TX
01
—
9R053
AR BCBS
AR
01
—
DA3920
RAILROAD MEDICARE
TX
Enumeration date
02/16/2007
Last updated
10/22/2007
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