Provider Demographics
NPI:1629609060
Name:GOOD4U FAMILY CLINIC DALLAS FORT WORTH DFWPLLC
Entity Type:Organization
Organization Name:GOOD4U FAMILY CLINIC DALLAS FORT WORTH DFWPLLC
Other - Org Name:GOOD4U FAMILY CLINIC
Other - Org Type:Other Name
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CHIBUZOR
Authorized Official - Middle Name:
Authorized Official - Last Name:NGWAKWE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-228-5447
Mailing Address - Street 1:1417 N COCKRELL HILL RD STE 106
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75211-1430
Mailing Address - Country:US
Mailing Address - Phone:214-228-5447
Mailing Address - Fax:469-778-0124
Practice Address - Street 1:1417 N COCKRELL HILL RD STE 101A
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75211-1308
Practice Address - Country:US
Practice Address - Phone:214-228-5447
Practice Address - Fax:469-778-0124
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-03
Last Update Date:2023-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX803342054OtherSTATE OF TEXAS
TX803342054Medicaid