Provider Demographics
NPI:1427312859
Name:RICHARDSON WALK IN CLINIC PLLC
Entity type:Organization
Organization Name:RICHARDSON WALK IN CLINIC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:JEFFREY
Authorized Official - Last Name:JENKS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:956-545-1694
Mailing Address - Street 1:930 E CAMPBELL RD
Mailing Address - Street 2:SUITE 106
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75081-2047
Mailing Address - Country:US
Mailing Address - Phone:956-545-1694
Mailing Address - Fax:
Practice Address - Street 1:930 E CAMPBELL RD
Practice Address - Street 2:SUITE 106
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75081-2047
Practice Address - Country:US
Practice Address - Phone:956-545-1694
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-29
Last Update Date:2012-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL1083261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXTXB161416Medicare PIN