| Martin Luther King Jr Family Clinic | |
|
2922 Martin Luther King Jr Blvd Building B Dallas TX 75215-2321 | |
| (214) 426-3645 | |
| (214) 446-2018 |
| Full Name | Martin Luther King Jr Family Clinic |
|---|---|
| Speciality | Clinic/Center |
| Location | 2922 Martin Luther King Jr Blvd, Dallas, Texas |
| Authorized Official Name and Position | Joyce Tapley (CHIEF EXECUTIVE OFFICER) |
| Authorized Official Contact | 2144263645 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Martin Luther King Jr Family Clinic 2922 Martin Luther King Jr Blvd Dallas TX 75215-2321 Ph: (214) 426-3645 | Martin Luther King Jr Family Clinic 2922 Martin Luther King Jr Blvd Building B Dallas TX 75215-2321 Ph: (214) 426-3645 |
| NPI Number | 1851492557 |
|---|---|
| Provider Enumeration Date | 09/26/2006 |
| Last Update Date | 04/08/2015 |
| Medicare PECOS PAC ID | 1456248673 |
|---|---|
| Medicare Enrollment ID | O20040302001300 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1851492557 | NPI | - | NPPES |
| 130713406 | Medicaid | TX | |
| 130713412 | Medicaid | TX | |
| 183600 | Medicaid | TX | |
| TXB104577 | Other | TX | MEDICARE PTAN |
| 130713404 | Medicaid | TX | |
| 130713410 | Medicaid | TX | |
| 183600 | Other | UNICARE | |
| 130713409 | Medicaid | TX | |
| QQ04 | Other | TX | BLUE CROSS BLUE SHIELD |
| 130713408 | Medicaid | TX | |
| 1949 | Medicaid | TX |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
| Provider Name | Sherry L Bowers |
|---|---|
| Provider Type | Practitioner - Podiatry |
| Provider Identifiers | NPI Number: 1538253083 PECOS PAC ID: 4385608215 Enrollment ID: I20041118001258 |
| Provider Name | Michael E Esedebe |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1952410037 PECOS PAC ID: 1850391871 Enrollment ID: I20061221000515 |
| Provider Name | Kimberly M Dobbins |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1013111343 PECOS PAC ID: 6103962196 Enrollment ID: I20111020000572 |
| Provider Name | John Alan Black |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1225330277 PECOS PAC ID: 9133377849 Enrollment ID: I20120920000565 |
| Provider Name | Brandi Gray Davis |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1619004264 PECOS PAC ID: 1052477841 Enrollment ID: I20141202000945 |
| Provider Name | Jilji Payikkattu |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1275950453 PECOS PAC ID: 5092039594 Enrollment ID: I20150109000701 |
| Provider Name | Anita I Dsouza |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1558860528 PECOS PAC ID: 3779839279 Enrollment ID: I20180712002102 |
| Provider Name | Stella Kingodi |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1013490754 PECOS PAC ID: 6901141639 Enrollment ID: I20181227000281 |
| Provider Name | Brandi Burnett |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1538668546 PECOS PAC ID: 7618201088 Enrollment ID: I20190619002156 |
| Provider Name | Ilia J Smith |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1245567643 PECOS PAC ID: 6901075431 Enrollment ID: I20190909001963 |
| Provider Name | Stephen J Epping |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1821443565 PECOS PAC ID: 9638462468 Enrollment ID: I20200205002181 |
| Provider Name | Dorothy C Marshall |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1023471927 PECOS PAC ID: 3173951977 Enrollment ID: I20200917000480 |
| Provider Name | Xaquita Wicks |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1790214989 PECOS PAC ID: 3173998861 Enrollment ID: I20230411002330 |
| Provider Name | Antonia Martin |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1376256164 PECOS PAC ID: 6709243827 Enrollment ID: I20230606000974 |
Perry K. Beckstrom, Do Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 3946 S Buckner Blvd Ste 200, Dallas, TX 75227 Phone: 214-381-7194 Fax: 214-381-7195 | |
John A. Demopulos, M.d., P.a. Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 7777 Forest Ln Ste B216, Dallas, TX 75230 Phone: 972-566-8380 | |
North Dallas Orthopedics & Rehabilitation, Pa Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 7777 Forest Ln, C-500, Dallas, TX 75230 Phone: 972-566-6366 Fax: 972-392-2011 | |
Abounding Prosperity, Inc. Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 1619 Martin Luther King Jr Blvd, Dallas, TX 75215 Phone: 469-778-0017 Fax: 469-778-0019 | |
Premier Medical Services Llc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 8300 Douglas Ave Suite 800, Dallas, TX 75225 Phone: 817-381-6813 | |
Metroplex Geriatric Associates Pa Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 9229 Lyndon B Johnson Fwy, Suite 250, Dallas, TX 75243 Phone: 972-739-3097 Fax: 972-739-2673 |