SENTINEL MEDICAL GROUP PLLC (NPI# 1689989238) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1689989238 |
| Entity Type | Organization |
| Organization Name | SENTINEL MEDICAL GROUP PLLC |
| Other Organization Name | THE CLINIC AT GREENTREE |
| Practice Address |
4706 Greentree Blvd Midland TX 79707-1610 |
| Practice Telephone | 4322187862 |
| Mailing Telephone | 4322187862 |
| Enumeration Date | 2010-08-06 |
| Last Update Date | 2011-09-28 |
| Authorized Official Name | MR. JACK KIM WILLIS JR. (MANAGING MEMBER) |
| Authorized Official Telephone | 4322187862 |
| Authorized Official Credential | P.A |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 207R00000X | Internal Medicine | E7559 | TX | Allopathic & Osteopathic Physicians |
| N | 363AM0700X |
Physician Assistant Specialization: Medical |
PA03268 | TX | Physician Assistants & Advanced Practice Nursing Providers |
| N | 363LF0000X |
Nurse Practitioner Specialization: Family |
623501 | TX | Physician Assistants & Advanced Practice Nursing Providers |
| Y | 363AM0700X |
Physician Assistant Specialization: Medical |
PA05950 | TX | Physician Assistants & Advanced Practice Nursing Providers |
| Other Name | Type Code |
|---|---|
| The Clinic at Greentree | Doing Business As Name - Organization |
| Street Address |
4706 GREENTREE BLVD |
| City | MIDLAND |
| State | TX |
| Zip Code | 79707-1610 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1548861164 | Daniel & Max, LLC | Optometrist | 3110 N Loop 250 W, Suite 200, Midland, TX 79707 | 2020-11-02 |
| 1396196036 | Endurance Inc | Pharmacy | 4906 Briarwood, Midland, TX 79707 | 2016-06-23 |
| 1841683356 | Carson Riley Phillips | Dentist | 4425 W Wadley Ave Ste 100, Midland, TX 79707 | 2015-03-07 |
| 1336538610 | Permian Basin Er II | Clinic/Center | 3201 N. Midland Drive, Ste 130, Midland, TX 79707 | 2015-01-09 |
| 1659776342 | Cvs Pharmacy Inc | Durable Medical Equipment & Medical Supplies | 5315 Briarwood Ave, Midland, TX 79707 | 2014-10-24 |
| 1982958799 | Tara Rae Nagel | Nurse Practitioner | 4214 Mamies Cir, Midland Pediatric Associates, Midland, TX 79707 | 2012-10-31 |
| 1336432046 | Ashley Thrasher Bell | Physician Assistant | 3600 N Garfield, Ttuhsc Pa Program, Midland, TX 79707 | 2011-05-27 |
| 1053626622 | Jerry Milton Lyon | Nurse Practitioner | 5000 Briarwood Ave Ste 203, Midland, TX 79707 | 2010-08-08 |
| 1053645838 | Marta Willoughby Md Pa | Clinic/Center | 3423 Caldera, Midland, TX 79707 | 2009-09-25 |
| 1326251950 | Bonnie Lloyd Clemmer | Registered Nurse | 3600 W Loop 250 North, Apt 1083, Midland, TX 79707 | 2007-05-08 |
| Find all providers in zip 79707 | ||||
| Taxonomy Code | 363AM0700X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| Specialization | Medical |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1619523644 | Lillian Moreno | Physician Assistant | 3600 N Garfield St., Midland, TX 79705 | 2019-08-15 |
| 1790251031 | Valarie Ramirez Alcala | Physician Assistant | 3400 Andrews Hwy, Midland, TX 79703-5100 | 2018-10-14 |
| 1487136537 | Heather Zamarron | Physician Assistant | 4400 N Midland Dr Ste 406b, Midland, TX 79707-3388 | 2018-09-05 |
| 1003214511 | Laura Sonnenburg | Physician Assistant | 4214 Andrews Hwy Ste 306, Midland, TX 79703-4870 | 2014-12-15 |
| 1437356730 | Johnny Lynn Flitton | Physician Assistant | 3401 Greenbriar, Suite 200, Midland, TX 79707-4652 | 2007-06-29 |
| 1942411038 | George Roger Vaillant | Physician Assistant | 119 Steele Creek Dr, Midland, GA 31820-4597 | 2007-05-24 |
| 1629139555 | Julie M. Davidson | Physician Assistant | 122 North N Street, Midland, TX 79701-6409 | 2006-12-13 |
| 1902994999 | Meredith Leigh Letzer | Physician Assistant | 4500 N Campus Ridge Dr, Midland, MI 48640-6123 | 2006-10-11 |
| 1538171616 | Midland Complete Family Care and Associates | Physician Assistant | 4310 W Illinois Ave, Ste 320, Midland, TX 79703-5529 | 2006-08-13 |
| 1437175163 | Nanette R Paredes | Physician Assistant | 400 Rosalind Redfern Grover Pkwy Ste 120, Midland, TX 79701-5849 | 2006-07-14 |
| Find all providers in MIDLAND | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.