South Loop 12 Medical Clinic Llc in Dallas - Family
South Loop 12 Medical Clinic Llc - NPI 1417034745
South Loop 12 Medical Clinic Llc is a Family in Dallas, Texas. South Loop 12 Medical Clinic Llc practices all healthcare services and medical treatments related to Family. The NPI Number for South Loop 12 Medical Clinic Llc is 1417034745. The last update date is 2014-10-09.
South Loop 12 Medical Clinic Llc's current location address is 3232 Great Trinity Forest Way, Dallas, Texas. You can contact this provider via phone number 2143984157 and fax number 2143984326. The mailing address for South Loop 12 Medical Clinic Llc is 3232 Great Trinity Forest Way, Dallas, Texas. To know further, please read the information below!
Provider Profile Detail
| Provider Organization | South Loop 12 Medical Clinic Llc |
|---|---|
| Address | 3232 Great Trinity Forest Way, Dallas, Texas |
| Phone Number | 2143984157 |
| Fax Number | 2143984326 |
| Sole Proprietor | -- |
| Credentials | -- |
Authorized Official
| Title or Position | FAMILY NUR |
|---|---|
| Authorized Official Name | Nellum Frances Connie |
| Credentials | MS, APRN-C |
| Telephone Number | 2143984157 |
NPI Number Detail
| NPI Number | 1417034745 |
|---|---|
| Provider Enumeration Date | 2006-11-01 |
| Last Updated Date | 2014-10-09 |
Provider Mailing Address Detail
| Address | 3232 Great Trinity Forest Way |
|---|---|
| City | Dallas |
| State | Texas (TX) |
| Post Code | 752167732 |
| Phone Number | 2143984157 |
| Fax Number | 2143984326 |
Provider's Primary Taxonomy Detail
| Speciality | Family |
|---|---|
| Taxonomy | 363Lf0000X |
| Licence No | 528675 |
|
Definition: An advanced practice registered nurse expert in primary healthcare for patients of all ages. |
|
Provider's Other Legacy Identifiers
| Identifier | Identifier Type | Identifier State | Identifier Issuer |
|---|---|---|---|
| 18919303 | TX | -- | |
| 5608640 | TX | FIRST HEALTH PROVIDER ID | |
| 7438197 | TX | AETNA PROVIDER ID# | |
| 8N8001 | TX | BCBC PROVIDER ID# |
Post Comment/ Review Below
What is the unique identifier code issued to South Loop 12 Medical Clinic Llc by the Centers for Medicare & Medicaid Services?
The South Loop 12 Medical Clinic Llc has been assigned the NPI (National Provider Identifier) 1417034745. This 10-digit code serves as a unique identification number for healthcare providers issued by the Centers for Medicare & Medicaid Services (CMS).
Could you provide the complete address where South Loop 12 Medical Clinic Llc is physically located?
The South Loop 12 Medical Clinic Llc is situated at the following address: 3232 Great Trinity Forest Way, Dallas, TX 752167732.
What is South Loop 12 Medical Clinic Llc's specialized area of practice, and what is the corresponding taxonomy classification code for this field?
The South Loop 12 Medical Clinic Llc's specialized field of practice is Family, and the corresponding taxonomy code that categorizes this area of specialization is 363Lf0000X.
On what date did the South Loop 12 Medical Clinic Llc receive the assignment of its 1417034745 from the Centers for Medicare & Medicaid Services?
The South Loop 12 Medical Clinic Llc was issued its 1417034745 by the Centers for Medicare & Medicaid Services on 2006-11-01.
When was the South Loop 12 Medical Clinic Llc's information last updated?
The South Loop 12 Medical Clinic Llc's information was last updated on 2014-10-09.
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