45D1000844 CLIA NUMBER - MALCOLM X PEDIATRIC CLINIC

Laboratory Demographics

CLIA Number: 45D1000844

Facility Name: MALCOLM X PEDIATRIC CLINIC

Facility Address:
4432 MALCOLM X BLVD
DALLAS, TX
ZIP 75215
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Facility Phone Number: 214 428-2010

Facility Type: Community Clinic

Certificate Type: Waiver

NPI Number: 1518290469

Taxonomy: 363L00000X - Nurse Practitioner
(1) A registered nurse provider with a graduate degree in nursing prepared for advanced practice involving independent and interdependent decision making and direct accountability for clinical judgment across the health care continuum or in a certified specialty. (2) A registered nurse who has completed additional training beyond basic nursing education and who provides primary health care services in accordance with state nurse practice laws or statutes. Tasks performed by nurse practitioners vary with practice requirements mandated by geographic, political, economic, and social factors. Nurse practitioner specialists include, but are not limited to, family nurse practitioners, gerontological nurse practitioners, pediatric nurse practitioners, obstetric-gynecologic nurse practitioners, and school nurse practitioners.

CLIA Record

Field Name	Field Value
CLIA Number	45D1000844
LAB Type	Community Clinic
Facility Name	MALCOLM X PEDIATRIC CLINIC
Street	4432 MALCOLM X BLVD
City	DALLAS
State	TX
ZIP	75215
Phone	214 428-2010
CertificateType	4
CertificateEffectiveDate	4/15/2023
CertificateExpirationDate	4/14/2025
FacilityType	Waiver

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This page was last updated on: 4/23/2024