1316475726 NPI number — MEDEX FAMILY HEALTH CLINIC INC

Table of content: LINNA LY PHARMD (NPI 1801347562)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1316475726 NPI number — MEDEX FAMILY HEALTH CLINIC INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MEDEX FAMILY HEALTH CLINIC INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1316475726
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/28/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5323 W COVE WAY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GRAND PRAIRIE
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75052-8631
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
410 E CAMP WISDOM RD STE 408
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DUNCANVILLE
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75116-2708
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
817-719-6092
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/30/2017

Additional Information

Authorized Official

Authorized Official Last Name:
ANINYE
Authorized Official First Name:
FRANCISCA
Authorized Official Middle Name:
Authorized Official Title or Position:
APRN, FNP-C
Authorized Official Telephone Number:
817-719-6092

Provider Taxonomy Codes

  • Taxonomy code: 261QU0200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QP2300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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