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

4550 Gus Thomasson Rd Suite 40
Mesquite, TX 75150

Phone

(972) 682-8917

Fax

(214) 206-3255

NPI assigned

Sep 22, 2009

Organization subpart

No

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

Authorized official

Name

Mr. Charles J. Wiltraut

Title

Executive Director

Phone

(972) 682-8917

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1437483583. Details of each certification follow.

• CCN 741810 Federally qualified health center · Active · Name & address match · Details

Federally qualified health center certification: CCN 741810

Legal name

MISSION EAST DALLAS AND METROPLEX

Certification status

Active

Provider type (POS)

Federally qualified health center

Participating since

Jan 17, 2013

Last certification

Jan 17, 2013

Ownership / control type

For profit – corporation

Facility address

2914 Oates Dr
Dallas, TX 75228

Locations

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

{
    "created_epoch": "1253577600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1534723200000",
    "number": "1437483583",
    "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": "4550 GUS THOMASSON RD SUITE 40",
            "city": "MESQUITE",
            "state": "TX",
            "postal_code": "75150",
            "telephone_number": "972-682-8917",
            "fax_number": "214-206-3255"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4550 Gus Thomasson Rd Ste 40",
            "address_purpose": "LOCATION",
            "city": "Mesquite",
            "state": "TX",
            "postal_code": "751501758",
            "country_code": "US",
            "telephone_number": "972-682-8917",
            "fax_number": "214-206-3255",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2914 Oates Dr",
            "address_purpose": "LOCATION",
            "city": "Dallas",
            "state": "TX",
            "postal_code": "752283914",
            "country_code": "US",
            "telephone_number": "972-682-8917 x112",
            "fax_number": "214-206-3255",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "MISSION EAST DALLAS AND METROPLEX PROJECT, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-09-22",
        "last_updated": "2018-08-20",
        "status": "A",
        "authorized_official_last_name": "WILTRAUT",
        "authorized_official_first_name": "CHARLES",
        "authorized_official_middle_name": "J.",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "972-682-8917",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "283855901",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Federally Qualified Health Center (FQHC) in Mesquite, TX
• Providers in Mesquite, 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 Aug 20, 2018; 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.