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NPI Code Detail

MEDICARE: MALCOLM X PEDIATRIC CLINIC

MEDICARE: MALCOLM X PEDIATRIC CLINIC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LF0000XFamily Nurse Practitioner245458TX
2363LP0200XPediatric Nurse Practitioner245458TX
3363L00000XNurse Practitioner245458TX

General Provider Information

NPI Number : 1518290469
Entity Type Code : Organization
Provider Name (Legal Business Name) : MALCOLM X PEDIATRIC CLINIC
Provider Business Mailing Address
First Line : 4432 MALCOLM X BLVD
Second Line :
City : DALLAS
State : TX
Zip : 75215-4349
Country : US
Telephone Number : 214-428-2010
Fax Number : 214-428-2065
Provider Business Practice Location Address
First Line : 4432 MALCOLM X BLVD
Second Line :
City : DALLAS
State : TX
Zip : 75215-4349
Country : US
Telephone Number : 214-428-2010
Fax Number : 214-428-2065
Authorized Official
Title or Position : OWNER
Name : RUTH GREER
Credential : FNP
Telephone Number : 214-428-2010
Provider Enumeration Date : 09/10/2009
Last Update Date : 09/10/2009

Similar Medicare Providers

1144314584 — MS. RUTH ELAINE GREER FNP
Practice Location Address:
4432 MALCOLM X BLVD
DALLAS, TX
75215-4349
Practice Phone: 214-428-2010
Practice Fax: 214-428-2065
1396844221 — DEMETRA CORRINE JONES DDS
Practice Location Address:
4432 MALCOLM X BLVD
DALLAS, TX
75215-4349
Practice Phone: 214-565-4330
Practice Fax: 214-565-7952
1063503571 — DALLAS DME,LLC
Practice Location Address:
4432 MALCOLM X BLVD , SUITE A
DALLAS, TX
75215-4349
Practice Phone: 214-928-9180
Practice Fax: 214-928-9982
1306962386 — DR DEANOS PHARMACY
Practice Location Address:
4432 MALCOLM X BLVD
DALLAS, TX
75215-4349
Practice Phone: 214-565-9898
Practice Fax: 212-565-9899
1801173786 — DALLAS NAVARRO HEALTHCARE SERVICES LLC
Practice Location Address:
4432 MALCOLM X BLVD
DALLAS, TX
75215-4349
Practice Phone: 214-428-2010
Practice Fax:
1801220488 — MRS. JACQUELINE LURECE DAVIS RN, FNP
Practice Location Address:
4432 MALCOLM X BLVD
DALLAS, TX
75215-4349
Practice Phone: 214-428-2010
Practice Fax: 214-428-2065

Directions to “MALCOLM X PEDIATRIC CLINIC ” Practice Location

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