Mission East Dallas and Metroplex Project, Inc.

Primary specialty

Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X

Legal business name

MISSION EAST DALLAS AND METROPLEX PROJECT, INC.

Practice address

4104 Junius St
Dallas, TX 75246-1427

Phone

(972) 682-8917

NPI assigned

Jun 1, 2022

Organization subpart

No

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

Authorized official

Name

Charles Joseph Wiltraut

Title

Ceo

Phone

(972) 682-8917

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Federally qualified health center certification: CCN 671031

Legal name

MISSION EAST DALLAS AND METROPLEX PROJECT, INC.

Certification status

Active

Provider type (POS)

Federally qualified health center

Participating since

Oct 5, 2022

Last certification

Oct 5, 2022

Ownership / control type

For profit – corporation

Facility address

4104 Junius St.
Dallas, TX 75246

Locations

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

{
    "created_epoch": "1654041600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1654041600000",
    "number": "1346989951",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4550 GUS THOMASSON RD STE 40",
            "city": "MESQUITE",
            "state": "TX",
            "postal_code": "751501758",
            "telephone_number": "972-682-8917"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4104 JUNIUS ST",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752461427",
            "telephone_number": "972-682-8917"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MISSION EAST DALLAS AND METROPLEX PROJECT, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-06-01",
        "last_updated": "2022-06-01",
        "certification_date": "2022-06-01",
        "status": "A",
        "authorized_official_last_name": "WILTRAUT",
        "authorized_official_first_name": "CHARLES",
        "authorized_official_middle_name": "JOSEPH",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "972-682-8917"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Federally Qualified Health Center (FQHC) in Dallas, TX
• Providers in Dallas, TX by specialty
• Federally Qualified Health Center (FQHC) in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 1, 2022; 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.