Provident Medical Center

Primary specialty

Clinic/CenterTaxonomy code 261Q00000X

License

E1172 Issued in TX

Legal business name

PROVIDENT MEDICAL CENTER

Practice address

831 Sr L Thornton Fwy
Dallas, TX 75203-2905

Phone

(214) 948-7783

Fax

(214) 948-7793

NPI assigned

Nov 21, 2006

Organization subpart

No

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

Authorized official

Name

Dr. Ronald Jeffrey Washington I, M.D

Title

Owner Administrator

Phone

(214) 948-7783

Specialties & licenses 1

Addresses

Other names 1

• Clinic Doing business as

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

{
    "created_epoch": "1164067200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1693958400000",
    "number": "1659446409",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "831 SR L THORNTON FWY",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752032905",
            "telephone_number": "214-948-7783",
            "fax_number": "214-948-7793"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "831 SR L THORNTON FWY",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752032905",
            "telephone_number": "214-948-7783",
            "fax_number": "214-948-7793"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROVIDENT MEDICAL CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-21",
        "last_updated": "2023-09-06",
        "status": "A",
        "authorized_official_last_name": "WASHINGTON",
        "authorized_official_first_name": "RONALD",
        "authorized_official_middle_name": "JEFFREY",
        "authorized_official_title_or_position": "OWNER ADMINISTRATOR",
        "authorized_official_telephone_number": "214-948-7783",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_name_suffix": "I",
        "authorized_official_credential": "M.D"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "TX",
            "license": "E1172",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Providence Group Home
• Providence Health Care Agency LLC
• Providence Home Care LLC
• Providence Senior Services, LLC
• Tiffany Overstreet Providence, DO
• Providers Association for Home Health,Hospice& Healthcare Agencies Inc
• Provisions Consulting Inc
• Provista Home Care LLC
• Jamie Stephen Provost II, MD
• Proximal Home Healthcare Inc

• Clinic/Center in Dallas, TX
• Providers in Dallas, TX by specialty
• Clinic/Center in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 6, 2023; 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.