=====================================================
General NPI Number Information
=====================================================
NPI Number | 1093994063
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SOUTHWESTERN FAMILY CLINIC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/26/2007
-----------------------------------------------------
Last Update Date | 10/26/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1927 E BELT LINE RD STE 146
-----------------------------------------------------
City | CARROLLTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75006-5814
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 214-731-3027
-----------------------------------------------------
Fax | 214-731-3033
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1927 E BELT LINE RD STE 146
-----------------------------------------------------
City | CARROLLTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75006-5814
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 214-731-3027
-----------------------------------------------------
Fax | 214-731-3033
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MEDICAL DIRECTOR
-----------------------------------------------------
Name | DAVID L HOBLIT
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 214-731-3027
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261Q00000X
-----------------------------------------------------
Taxonomy Name | Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------