Provider Demographics
NPI:1619583754
Name:MAINSPRING FAMILY CARE LLC / MAINSPRING FAMILY CLINIC
Entity Type:Organization
Organization Name:MAINSPRING FAMILY CARE LLC / MAINSPRING FAMILY CLINIC
Other - Org Name:MAINSPRING FAMILY CARE
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHOLA
Authorized Official - Middle Name:
Authorized Official - Last Name:AKINFIRESOYE
Authorized Official - Suffix:
Authorized Official - Credentials:DNP, FNP-BC
Authorized Official - Phone:682-472-2607
Mailing Address - Street 1:2024 LIMESTONE DR
Mailing Address - Street 2:
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75052-2693
Mailing Address - Country:US
Mailing Address - Phone:682-472-2607
Mailing Address - Fax:
Practice Address - Street 1:609 S MAIN ST
Practice Address - Street 2:
Practice Address - City:DUNCANVILLE
Practice Address - State:TX
Practice Address - Zip Code:75116-4713
Practice Address - Country:US
Practice Address - Phone:682-472-2607
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-22
Last Update Date:2020-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center