Organization
MARTIN LUTHER KING JR FAMILY CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. JOYCE TAPLEY CEO (CHIEF EXECUTIVE OFFICER)
(214) 426-3645
Entity
Organization
Contact information
Practice address
2922 MARTIN LUTHER KING JR BLVD, BUILDING B, DALLAS, TX 75215-2321
(214) 426-3645
(214) 446-2018
Mailing address
2922 MARTIN LUTHER KING JR BLVD, DALLAS, TX 75215-2321
(214) 426-3645
(214) 446-2018
Taxonomy
Speciality
Code
Description
License number
State
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
130713404
—
TX
05
—
130713406
—
TX
05
—
130713408
—
TX
05
—
130713409
—
TX
05
—
130713410
—
TX
05
—
130713412
—
TX
01
—
183600
UNICARE
—
05
—
183600
—
TX
05
—
1949
—
TX
01
—
QQ04
BLUE CROSS BLUE SHIELD
TX
01
—
TXB104577
MEDICARE PTAN
TX
Enumeration date
09/26/2006
Last updated
04/08/2015
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