FORMULA WELLNESS PLLC NPI 1346608536

NPI Information

NPI: 1346608536
Provider Name: FORMULA WELLNESS PLLC
Classification: Family Medicine - 207Q00000X
Entity Type: Organization

CLIA Number: 45D2191410

Address:
4342 LOVERS LN
DALLAS, TX
ZIP 75225
Phone: (214) 931-9443
Get Directions

FORMULA WELLNESS PLLC is a family medicine in Dallas, TX. The provider is family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. FORMULA WELLNESS PLLC NPI is 1346608536. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

4342 LOVERS LN
DALLAS, TX
ZIP 75225-921
Phone: (214) 931-9443
Fax: (214) 602-2017

The provider's authorized official is Brian Rudman .
The authorized official title is Physician/owner and has the following contact phone number (214) 931-9443.

The CLIA number assigned to this NPI record is 45D2191410 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 2/3/2016 and was last updated on 9/6/2017.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	License Number	License State	Primary
1	207L00000X	Anesthesiology	K1038	TEXAS	No
2	207Q00000X	Family Medicine	K1038	TEXAS	Yes
3	261Q00000X	Clinic/Center			No

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	129767308	MEDICAID	TEXAS

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/14/2023

NPI Synchronization or Removal

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