Organization
WELLCARE FAMILY CLINIC, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. GODLING OBI ONYEGBUNWA (ADMINISTRATOR)
(972) 704-5550
Entity
Organization
Contact information
Practice address
18110 MIDWAY RD STE 136, DALLAS, TX 75287-6632
(214) 613-6009
(214) 613-6002
Mailing address
18110 MIDWAY RD STE 136, DALLAS, TX 75287-6632
(972) 704-5550
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
—
—
261QP2300X
Primary Care Clinic/Center
—
—
363LF0000X
Family Nurse Practitioner
—
—
Other
Enumeration date
01/29/2019
Last updated
04/11/2022
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