NPIMap

Organization Active NPI

Malcolm X Pediatric Clinic

  • Primary Care Clinic/Center
  • Dallas, TX
National Provider Identifier
1982904165
Registry record updated Oct 22, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Clinic/CenterTaxonomy code 261QP2300X
License
2-45458 Issued in TX
Legal business name
MALCOLM X PEDIATRIC CLINIC
Practice address
4432 Malcolm X Blvd.
Dallas, TX 75215
Phone
(214) 428-2010
Fax
(214) 428-2065
NPI assigned
Oct 22, 2010
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 22, 2010

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

Authorized official

Name
Ms. Ruth Elaine Greer, NP-C
Title
Owner
Phone
(214) 428-2010

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Primary Care Clinic/Center 261QP2300X 2-45458 TX Primary

Addresses

Primary practice location

4432 Malcolm X Blvd.
Dallas, TX 75215

Mailing address

4432 Malcolm X Blvd.
Dallas, TX 75215
Phone (214) 428-2010

Other identifiers 3

IdentifierTypeStateIssuer
121321704MedicaidTX
121321702MedicaidTX
1213217-02MedicaidTX

National Provider Directory

National Provider Directory
Tax ID family
Malcolm X Pediatric Clinic2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

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

{
    "created_epoch": "1287705600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1287705600000",
    "number": "1982904165",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4432 MALCOLM X BLVD.",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "75215",
            "telephone_number": "214-428-2010",
            "fax_number": "214-428-2065"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4432 MALCOLM X BLVD.",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "75215",
            "telephone_number": "214-428-2010",
            "fax_number": "214-428-2065"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MALCOLM X PEDIATRIC CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-10-22",
        "last_updated": "2010-10-22",
        "status": "A",
        "authorized_official_last_name": "GREER",
        "authorized_official_first_name": "RUTH",
        "authorized_official_middle_name": "ELAINE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "214-428-2010",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "NP-C"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "TX",
            "license": "2-45458",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "121321704",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "121321702",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1213217-02",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Dallas, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 22, 2010; 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.