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General NPI Number Information
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NPI Number | 1104928431
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Entity Type | Organization
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Legal Business Name | MIDLOTHIAN FAMILY MEDICINE CLINIC
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Dates
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Enumeration Date | 09/05/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 200 SILKEN XING SUITE 201
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City | MIDLOTHIAN
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State | TX
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Zip | 76065-5586
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Country | US
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Telephone | 972-723-1185
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Fax | 972-723-4003
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Provider Business Mailing Address
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Address Line | 200 SILKEN CROSSING SUITE 201
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City | MIDLOTHIAN
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State | TX
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Zip | 76065
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Country | US
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Telephone | 972-723-1185
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Fax | 972-723-4003
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Authorized Official
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Title or Position | OWNER
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Name | DR. BOB KELLY FELTY
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Credential | MD
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Telephone | 972-723-1185
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | H6210
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License Number State | TX
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