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NPI Code Detail

MEDICARE: MARTIN LUTHER KING JR FAMILY CLINIC

MEDICARE: MARTIN LUTHER KING JR FAMILY 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
1251K00000XPublic Health or Welfare AgencyTX

General Provider Information

NPI Number : 1841288602
Entity Type Code : Organization
Provider Name (Legal Business Name) : MARTIN LUTHER KING JR FAMILY CLINIC
Provider Business Mailing Address
First Line : 2922-B MARTIN LUTHER KING JR BLVD
Second Line :
City : DALLAS
State : TX
Zip : 75215
Country : US
Telephone Number : 214-426-3645
Fax Number : 214-426-6813
Provider Business Practice Location Address
First Line : 2922-B MARTIN LUTHER KING JR BLVD
Second Line :
City : DALLAS
State : TX
Zip : 75215-2471
Country : US
Telephone Number : 214-426-3645
Fax Number : 214-426-6813
Authorized Official
Title or Position : BILLING/CREDENTIALING COORDINATOR
Name : MS. CHANTEL DENISE MILLER
Credential : BILLING
Telephone Number : 214-426-3645
Provider Enumeration Date : 10/06/2005
Last Update Date : 08/22/2020

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