Provider Demographics
NPI:1952982068
Name:UMBRELLA CARE MULTI SPECIALITY CENTER LLC
Entity type:Organization
Organization Name:UMBRELLA CARE MULTI SPECIALITY CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:NIKKISHA
Authorized Official - Middle Name:JOHNSON
Authorized Official - Last Name:POLK
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:812-486-1209
Mailing Address - Street 1:8750 PARK LN
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75231-1219
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8750 PARK LN
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231-1219
Practice Address - Country:US
Practice Address - Phone:832-264-1457
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-20
Last Update Date:2021-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty