| Broadway I-30 Medical Clinic, Pllc | |
|
407 W Interstate 30 Garland TX 75043-5912 | |
| (972) 240-8539 | |
| (972) 303-1994 |
| Full Name | Broadway I-30 Medical Clinic, Pllc |
|---|---|
| Speciality | Family Medicine |
| Location | 407 W Interstate 30, Garland, Texas |
| Authorized Official Name and Position | Carlton K Clarke (MEDICAL DIRECTOR-OWNER) |
| Authorized Official Contact | 2148034516 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Broadway I-30 Medical Clinic, Pllc 407 W Interstate 30 Garland TX 75043-5912 Ph: (972) 240-8539 | Broadway I-30 Medical Clinic, Pllc 407 W Interstate 30 Garland TX 75043-5912 Ph: (972) 240-8539 |
| NPI Number | 1992157697 |
|---|---|
| Provider Enumeration Date | 07/06/2016 |
| Last Update Date | 07/06/2016 |
| Medicare PECOS PAC ID | 0547519654 |
|---|---|
| Medicare Enrollment ID | O20180823000805 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1992157697 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | F0154 (Texas) | Primary |
| 207V00000X | Obstetrics & Gynecology | L4890 (Texas) | Secondary |
| Provider Name | Carlton K Clarke |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1467452649 PECOS PAC ID: 3779497649 Enrollment ID: I20031114000452 |
| Provider Name | Carlton K Clarke |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1033153192 PECOS PAC ID: 0840202586 Enrollment ID: I20060622000034 |
| Provider Name | Mohammed H Al-haider |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1750640249 PECOS PAC ID: 6204158611 Enrollment ID: I20181002002937 |
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