Beulah Family Clinic Professional Limited Liability Company
Clinic/Center in Desoto, TX. Organization (NPI-2).
NPI number1750144150
StatusActive
Last updated in NPPESJun 28, 2024
Details
- NPI
- 1750144150
- Entity type
- Organization (NPI-2)
- Legal business name
- Beulah Family Clinic Professional Limited Liability Company
- Organization subpart
- No
- Enumeration date
- Jan 30, 2024
- Certification date
- Jun 20, 2024
- Last updated
- Jun 28, 2024
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 261Q00000X | Clinic/Center | – | – | Yes |
Other names
- Beulah Medical Clinic (Other Name)
Practice location
1534-A N Hampton RoadSuite 100
Desoto, TX 75115-0073
Phone 469-585-8129
Mailing address
1534a N Hampton RdDesoto, TX 75115-2302
Authorized official
Patrick Moneke
Administrator
8173660950
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