Healthcare Provider Details

I. General information

NPI: 1528244290
Provider Name (Legal Business Name): JOS INC ROUTH STREET WOMENS CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/12/2008
Last Update Date: 06/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4321 N CENTRAL EXPY
DALLAS TX
75205-4524
US

IV. Provider business mailing address

4321 N CENTRAL EXPY
DALLAS TX
75205-4524
US

V. Phone/Fax

Practice location:
  • Phone: 214-748-8611
  • Fax:
Mailing address:
  • Phone: 214-748-8611
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0005X
TaxonomyAmbulatory Family Planning Facility
License Number007278
License Number StateTX

VIII. Authorized Official

Name: MRS. VIRGINIA BRAUN
Title or Position: CO-OWNER
Credential:
Phone: 214-748-8611