Provider Demographics
NPI:1407274855
Name:MARTIN LUTHER KING, JR. FAMILY CLINIC
Entity Type:Organization
Organization Name:MARTIN LUTHER KING, JR. FAMILY CLINIC
Other - Org Name:FOREMOST FAMILY HEALTH CENTERS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:JOYCE
Authorized Official - Middle Name:E
Authorized Official - Last Name:TAPLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-426-3645
Mailing Address - Street 1:PO BOX 150128
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75315-0128
Mailing Address - Country:US
Mailing Address - Phone:214-426-3645
Mailing Address - Fax:214-421-0937
Practice Address - Street 1:3515 SHEPHERD LN
Practice Address - Street 2:
Practice Address - City:BALCH SPRINGS
Practice Address - State:TX
Practice Address - Zip Code:75180-2325
Practice Address - Country:US
Practice Address - Phone:972-588-4532
Practice Address - Fax:214-888-3149
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MARTIN LUTHER KINFG, JR. FAMILY CLINIC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-04-02
Last Update Date:2014-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)