| Family Affair Medical Clinic Llc | |
|
3729 Shady Hollow Ln Dallas TX 75233-3707 | |
| (832) 454-9453 | |
| Not Available |
| Full Name | Family Affair Medical Clinic Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 3729 Shady Hollow Ln, Dallas, Texas |
| Authorized Official Name and Position | Nicole Crowder (DIRECTOR) |
| Authorized Official Contact | 8324549453 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Family Affair Medical Clinic Llc Po Box 763552 Dallas TX 75376-3552 Ph: (832) 454-9453 | Family Affair Medical Clinic Llc 3729 Shady Hollow Ln Dallas TX 75233-3707 Ph: (832) 454-9453 |
| NPI Number | 1831808427 |
|---|---|
| Provider Enumeration Date | 11/22/2022 |
| Last Update Date | 12/06/2022 |
| Medicare PECOS PAC ID | 1153791595 |
|---|---|
| Medicare Enrollment ID | O20221230000021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1831808427 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM1300X | Clinic/center - Multi-specialty | (* (Not Available)) | Primary |
| 363LF0000X | Nurse Practitioner - Family | (* (Not Available)) | Secondary |
| Provider Name | Nicole Dainese Crowder |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1366050981 PECOS PAC ID: 7012309743 Enrollment ID: I20220110000569 |
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