Organization
MISSION EAST DALLAS AND METROPLEX PROJECT, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. CHARLES J. WILTRAUT (EXECUTIVE DIRECTOR)
(972) 682-8917
Entity
Organization
Contact information
Practice address
4550 GUS THOMASSON RD SUITE 40, MESQUITE, TX 75150
(972) 682-8917
(214) 206-3255
Mailing address
4550 GUS THOMASSON RD STE 40, MESQUITE, TX 75150-1758
(972) 682-8917
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
—
—
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
283855901
—
TX
Enumeration date
09/22/2009
Last updated
08/20/2018
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