Martin Luther King Jr Family Clinic

Primary specialty

Clinic PharmacyTaxonomy code 3336C0002X

License

11893 Issued in TX

Legal business name

MARTIN LUTHER KING JR FAMILY CLINIC

Practice address

2922 Martin Luther King Jr Blvd
B
Dallas, TX 75215-2321

Phone

(214) 426-3645

Fax

(214) 426-6813

NPI assigned

Jan 12, 2009

Organization subpart

No

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

Authorized official

Name

Mrs. Joyce Tapley

Title

Ceo

Phone

(214) 426-3645

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in TX

Enrollment records 1

Federally qualified health center certification: CCN 451816

Legal name

MARTIN LUTHER KING JR FAMILY CLINIC

Certification status

Active

Provider type (POS)

Federally qualified health center

Participating since

Oct 1, 1991

Last certification

Oct 1, 1991

Ownership / control type

For profit – corporation

Organization structure

CorporationNon-profit

Incorporated

Oct 25, 1985

Enrollment address

2922 Martin Luther King Jr Blvd B
Dallas, TX 75215-2321

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

• Martin Luther King Jr Family Clinic

  • Federally Qualified Health Center (FQHC)
  • Dallas, TX
  • NPI 1851492557

  O20111201000398

  Same enrollment

All disclosed owners & managing parties 1

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

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

{
    "created_epoch": "1231718400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1341187200000",
    "number": "1134366289",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 150128",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "753150128",
            "telephone_number": "214-426-3645",
            "fax_number": "214-426-6813"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2922 MARTIN LUTHER KING JR BLVD",
            "address_2": "B",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752152321",
            "telephone_number": "214-426-3645",
            "fax_number": "214-426-6813"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARTIN LUTHER KING JR FAMILY CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-01-12",
        "last_updated": "2012-07-02",
        "status": "A",
        "authorized_official_last_name": "TAPLEY",
        "authorized_official_first_name": "JOYCE",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "214-426-3645",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "3336C0002X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Clinic Pharmacy",
            "state": "TX",
            "license": "11893",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "130713404",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCPDP PROVIDER ID",
            "identifier": "4576229",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Marissa Kelly Marti-Smith, N.P
• Angela Martilik, LPC
• Concepcion Martin de Bustamante
• Martin H. Schaffer M.D.,P.a.
• Maureen Virginia Martin Jamieson, DC
• Martin Luther King Jr Family Clinic
• Martin Luther King Jr Family Clinic
• Martin Luther King Jr Family Clinic
• Martin McElya DO PA
• Martin S.Posner MD Associated

• Clinic Pharmacy in Dallas, TX
• Providers in Dallas, TX by specialty
• Clinic Pharmacy in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 2, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.