Provider Demographics
NPI:1245560069
Name:NORTH TEXAS HOME VISITING PHYSICIANS & CLINIC
Entity Type:Organization
Organization Name:NORTH TEXAS HOME VISITING PHYSICIANS & CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MAC
Authorized Official - Middle Name:
Authorized Official - Last Name:OKWAH
Authorized Official - Suffix:
Authorized Official - Credentials:MSSW
Authorized Official - Phone:214-453-0064
Mailing Address - Street 1:3225 INTERSTATE 30
Mailing Address - Street 2:SUITE H1
Mailing Address - City:MESQUITE
Mailing Address - State:TX
Mailing Address - Zip Code:75150-2635
Mailing Address - Country:US
Mailing Address - Phone:214-453-0064
Mailing Address - Fax:214-453-0074
Practice Address - Street 1:3225 INTERSTATE 30
Practice Address - Street 2:SUITE H1
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75150-2635
Practice Address - Country:US
Practice Address - Phone:214-453-0064
Practice Address - Fax:214-453-0074
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-29
Last Update Date:2009-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center