| The Kingsley Clinic Pllc | |
|
14180 Dallas Pkwy Ste 620 Dallas TX 75254-4363 | |
| (530) 305-7637 | |
| Not Available |
| Full Name | The Kingsley Clinic Pllc |
|---|---|
| Speciality | Internal Medicine |
| Location | 14180 Dallas Pkwy Ste 620, Dallas, Texas |
| Authorized Official Name and Position | James Ralph Kingsley (CHIEF EXECUTIVE OFFICER) |
| Authorized Official Contact | 5303057637 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| The Kingsley Clinic Pllc 33471 Biltmore Dr Temecula CA 92592-1849 Ph: (530) 305-7637 | The Kingsley Clinic Pllc 14180 Dallas Pkwy Ste 620 Dallas TX 75254-4363 Ph: (530) 305-7637 |
| NPI Number | 1770143315 |
|---|---|
| Provider Enumeration Date | 06/17/2019 |
| Last Update Date | 01/31/2024 |
| Medicare PECOS PAC ID | 7113348616 |
|---|---|
| Medicare Enrollment ID | O20200610000408 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1770143315 | NPI | - | NPPES |
| R2380 | Other | TX | STATE MEDICAL LICENSE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (* (Not Available)) | Primary |
| 261QM1300X | Clinic/center - Multi-specialty | (* (Not Available)) | Secondary |
| Provider Name | James Ralph Kingsley |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1841687142 PECOS PAC ID: 8325316326 Enrollment ID: I20170615002071 |
| Provider Name | Danial A Soleja |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1770970451 PECOS PAC ID: 6002163631 Enrollment ID: I20180727000341 |
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