| NPI | 1043351760 |
|---|---|
| NPI Type | NPI-2 Organization |
| Status | Active |
| Enumeration Date | 2007-02-08 |
| Last Updated | 2011-07-26 |
| Authorized Official | El Greco Roberts Vice President of Business Affairs Phone: 2143721051 |
| Mailing Address | 3436 S Polk St Dallas, TX 75224-3804 United States Phone: (214) 372-1051 | Fax: (214) 372-9201 📍 View Map |
| Primary Practice Address | 3436 S Polk St Dallas, TX 75224-3804 United States Phone: (214) 372-1051 | Fax: (214) 372-9201 📍 View Map |
| Issuer | State | Number | Other Issuer |
|---|---|---|---|
| Other (non-Medicare) | TX | 0041PN | BLUE CROSS BLUE SHIELD OF TEXAS |
| Other (non-Medicare) | TX | 10008701 | AMERIGROUP |
| MEDICAID | TX | 155741503 | — |
| Other (non-Medicare) | TX | 4567567 | Cigna |
| Other (non-Medicare) | TX | 562313709 | old tax id |
| Other (non-Medicare) | TX | 7149594 | Aetna |
| Other (non-Medicare) | TX | NP7128 | blue cross blue shield |
| MEDICAID | TX | 155741504 | — |
| MEDICAID | TX | 190227201 | — |
| MEDICAID | TX | 190227202 | — |
| Primary | Taxonomy Code & Description | State | License Number |
|---|---|---|---|
| Yes | 363L00000X – Nurse Practitioner | TX | 578285 |
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About NPI 1043351760
South Polk Medical Clinic Llc is an organization registered in the CMS NPPES NPI Registry with NPI number 1043351760. The primary specialty listed is Nurse Practitioner. The organization is located in Dallas, TX. This NPI is classified as a Type 2 (Organizational) NPI and is currently active. The NPI was first enumerated (assigned) on 2007-02-08. All data is sourced directly from the official CMS NPPES public API and is updated daily.
Frequently Asked Questions
What is NPI 1043351760?
NPI 1043351760 belongs to South Polk Medical Clinic Llc, a Nurse Practitioner in Dallas, TX. It is a Type 2 Organizational NPI registered in the CMS NPPES NPI Registry.
Is NPI 1043351760 active?
The current status of NPI 1043351760 in the NPPES registry is Active. The record was last updated on 2011-07-26.
What specialty is NPI 1043351760?
NPI 1043351760 is classified under the taxonomy Nurse Practitioner. Taxonomy codes in NPPES are maintained by the National Uniform Claim Committee (NUCC) and identify the provider's type, classification, and specialization.
How do I verify NPI 1043351760?
You can verify NPI 1043351760 at the official CMS NPPES website at npiregistry.cms.hhs.gov or using our free NPI Lookup tool above. All data shown on this page is sourced directly from the official NPPES public API and is updated daily by CMS.
What address is on file for NPI 1043351760?
The primary practice address on file for NPI 1043351760 is 3436 S Polk St, Dallas, TX 75224-3804. This address is registered in the NPPES system and providers are required to update it within 30 days of any change.
When was NPI 1043351760 issued?
NPI 1043351760 was first issued (enumerated) on 2007-02-08. The NPPES record was last updated on 2011-07-26.
Practice Location Map
South Polk Medical Clinic Llc is located at 3436 S Polk St, Dallas, TX. Use the map below to find directions or verify the practice location.
Related Healthcare Providers
The following providers share the same practice location, specialty, or state as South Polk Medical Clinic Llc. All records sourced from the CMS NPPES registry.
License Information
The following state license numbers are on file in the NPPES registry for NPI 1043351760. For license status verification, contact the relevant state licensing board directly.
| Specialty / Taxonomy | License Number | State |
|---|---|---|
| Nurse Practitioner | 578285 | TX |