Provider Demographics
NPI:1942674296
Name:DFW COMMUNITY MEDICAL GROUP PLLC
Entity Type:Organization
Organization Name:DFW COMMUNITY MEDICAL GROUP PLLC
Other - Org Name:COMMUNITY MEDICAL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HATSHEPSUT
Authorized Official - Middle Name:
Authorized Official - Last Name:OSHUN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:267-242-3404
Mailing Address - Street 1:1901 W IRVING BLVD
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75061-6823
Mailing Address - Country:US
Mailing Address - Phone:214-570-0006
Mailing Address - Fax:469-586-5909
Practice Address - Street 1:916 W 6TH ST
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75060-3874
Practice Address - Country:US
Practice Address - Phone:214-570-0006
Practice Address - Fax:469-586-5909
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-24
Last Update Date:2024-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363A00000X
TXAP128978363LF0000X, 261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/CenterGroup - Multi-Specialty
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty