Family Medical Clinic of Mesquite, PA

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

D3614 Issued in TX

Legal business name

FAMILY MEDICAL CLINIC OF MESQUITE, PA

Practice address

2540 N Galloway Ave
Suite 103
Mesquite, TX 75150-6306

Phone

(972) 279-6595

Fax

(972) 613-3737

NPI assigned

Jun 13, 2008

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Joel D. Holliday, D.O.

Title

Owner

Phone

(972) 279-6595

Specialties & licenses 1

Addresses

Other identifiers 2

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1213315200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1415836800000",
    "number": "1104086966",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2540 N GALLOWAY AVE",
            "address_2": "SUITE 103",
            "city": "MESQUITE",
            "state": "TX",
            "postal_code": "751506306",
            "telephone_number": "972-279-6595",
            "fax_number": "972-613-3737"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2540 N GALLOWAY AVE",
            "address_2": "SUITE 103",
            "city": "MESQUITE",
            "state": "TX",
            "postal_code": "751506306",
            "telephone_number": "972-279-6595",
            "fax_number": "972-613-3737"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAMILY MEDICAL CLINIC OF MESQUITE, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-06-13",
        "last_updated": "2014-11-13",
        "status": "A",
        "authorized_official_last_name": "HOLLIDAY",
        "authorized_official_first_name": "JOEL",
        "authorized_official_middle_name": "D.",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "972-279-6595",
        "authorized_official_credential": "D.O."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": "TX",
            "license": "D3614",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "201526501",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE RAIL ROAD",
            "identifier": "DP1469",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 13, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.