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BROADWAY I-30 MEDICAL CLINIC PLLC NPI 1992157697


NPI Information

NPI: 1992157697
Provider Name: BROADWAY I-30 MEDICAL CLINIC, PLLC
Classification: Family Medicine - 207Q00000X
Entity Type: Organization

CLIA Number: 45D0958439

Address:
407 W INTERSTATE 30
GARLAND, TX
ZIP 75043
Phone: (972) 240-8539
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BROADWAY I-30 MEDICAL CLINIC, PLLC is a family medicine in Garland, TX. The provider is family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. BROADWAY I-30 MEDICAL CLINIC, PLLC NPI is 1992157697. The provider is registered as an organization entity type and is a multi-specialty group.

The provider's business location address is:

407 W INTERSTATE 30
GARLAND, TX
ZIP 75043-912
Phone: (972) 240-8539
Fax: (972) 303-1994

The provider's authorized official is Carlton K Clarke .
The authorized official title is Medical Director-owner and has the following contact phone number (214) 803-4516.

The CLIA number assigned to this NPI record is 45D0958439 - physician office with a certificate type of Certificate for Provider-Performed Microscopy Procedures (PPMP).

The enumeration date for this NPI number is 7/6/2016 and was last updated on 7/6/2016.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1207V00000XObstetrics & GynecologyL4890TEXASNo
2207Q00000XFamily MedicineF0154TEXASYes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

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