Organization
PROVIDENT MEDICAL CENTER
Active
Organization
PROVIDENT MEDICAL CENTER
Active
Other names
Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RONALD JEFFREY WASHINGTON I M.D (OWNER ADMINISTRATOR)
(214) 948-7783
Entity
Organization
Contact information
Practice address
831 SR L THORNTON FWY, DALLAS, TX 75203-2905
(214) 948-7783
(214) 948-7793
Mailing address
831 SR L THORNTON FWY, DALLAS, TX 75203-2905
(214) 948-7783
(214) 948-7793
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
E1172
TX
Other
Enumeration date
11/21/2006
Last updated
09/06/2023
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