Provider Demographics
NPI:1154560027
Name:MERCY FAMILY CLINIC
Entity type:Organization
Organization Name:MERCY FAMILY CLINIC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/ CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:EBERE
Authorized Official - Middle Name:ISRAEL
Authorized Official - Last Name:AZUBUIKE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:214-942-2377
Mailing Address - Street 1:2409 ALCO AVE
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75211-2614
Mailing Address - Country:US
Mailing Address - Phone:214-942-2377
Mailing Address - Fax:214-942-2977
Practice Address - Street 1:2409 ALCO AVE
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75211-2614
Practice Address - Country:US
Practice Address - Phone:214-942-2377
Practice Address - Fax:214-942-2977
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-17
Last Update Date:2023-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM9136207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0069SDOtherBCBS OF TX
TXM9136OtherLICENCE
TX0069SDOtherBCBS OF TX
TXNO158163OtherDPS
TXFA0844503OtherDEA