MARTIN LUTHER KING JR FAMILY CLINIC NPI 1851492557

NPI Information

MARTIN LUTHER KING JR FAMILY CLINIC is a federally qualified health center (fqhc) clinic center in Dallas, TX. MARTIN LUTHER KING JR FAMILY CLINIC NPI is 1851492557. The provider is registered as an organization entity type.

The provider's business location address is:

2922 MARTIN LUTHER KING JR BLVD
BUILDING B
DALLAS, TX
ZIP 75215-321
Phone: (214) 426-3645
Fax: (214) 446-2018

The provider's authorized official is Joyce Tapley .
The authorized official title is Chief Executive Officer and has the following contact phone number (214) 426-3645.

The CLIA number assigned to this NPI record is 45D0051690 - federally qualified health center with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 9/26/2006 and was last updated on 4/8/2015.

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:

Other Identifiers

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

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