PEDIATRIC URGENT CARE CENTER OF FORT WORTH, P.A.. (NPI# 1851668149) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1851668149 |
| Entity Type | Organization |
| Organization Name | PEDIATRIC URGENT CARE CENTER OF FORT WORTH, P.A.. |
| Practice Address |
3400 Texas Sage Trail Suite 148 Fort Worth TX 76177 |
| Mailing Address |
3120 Westcliff Rd W Fort Worth TX 76109-2128 |
| Practice Telephone | 8172714309 |
| Mailing Telephone | 8172714309 |
| Enumeration Date | 2011-11-30 |
| Last Update Date | 2011-11-30 |
| Authorized Official Name | DR. MICHAEL RAY COWAN (OWNER) |
| Authorized Official Telephone | 8172714309 |
| Authorized Official Credential | D.O. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207PP0204X |
Emergency Medicine Specialization: Pediatric Emergency Medicine |
H9459 | TX | Allopathic & Osteopathic Physicians |
| Street Address |
3400 TEXAS SAGE TRAIL SUITE 148 |
| City | FORT WORTH |
| State | TX |
| Zip Code | 76177 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1225685449 | Cody Brown Dds Pllc | Dentist | 2701 W Heritage Trace Pkwy, Ste 130, Fort Worth, TX 76177 | 2019-08-22 |
| 1144782889 | Daniel Max & Marcandrea LLC | Optometrist | 8901 N. Freeway Service Rd E, Ste 105, Fort Worth, TX 76177 | 2019-04-02 |
| 1194296202 | Fresenius Medical Care Keller, LLC | Clinic/Center | 3700 N Tarrant Pkwy, Fort Worth, TX 76177 | 2018-12-16 |
| 1861961310 | Daniel Max & Marcandrea, LLC | Optometrist | 3524 Highway 114, Suite 300, Forth Worth, TX 76177 | 2018-11-14 |
| 1447732896 | Alexis Etienne Ingleton | Assisted Living Facility | 15840 Badger Creek Lm, Fort Worth, TX 76177 | 2018-09-02 |
| 1023526365 | J&l Dental Group, Pllc | Clinic/Center | 2401 Heritage Trace Parkway, Suite 121, Fort Worth, TX 76177 | 2018-01-22 |
| 1689115438 | Hayley Blackwood | Psychologist | 15833 Bent Rose Way, Fort Worth, TX 76177 | 2017-03-13 |
| 1013463256 | Elianne Griselle Alarcon | Dentist | 8917 N. Freeway, Suite 117, Fort Worth, TX 76177 | 2016-08-28 |
| 1962877373 | Home Town Dental Alliance | Dentist | 8901 Tehama, Suite 119, Forth Worth, TX 76177 | 2015-12-10 |
| 1003280686 | Susan Akberzie | Nurse Practitioner | 3400 Texas Sage Trl Ste 148, Fort Worth, TX 76177 | 2015-11-19 |
| Find all providers in zip 76177 | ||||
| Taxonomy Code | 207PP0204X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Emergency Medicine |
| Specialization | Pediatric Emergency Medicine |
| Pediatric Emergency Medicine is a clinical subspecialty that focuses on the care of the acutely ill or injured child in the setting of an emergency department. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source] Additional Resources: American Board of Emergency Medicine, 2007. http://www.abem.org/public/ Board certification is provided by the American Board of Emergency Medicine. Board certification for Medical Doctors (MDs) is provided by the American Board of Emergency Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1316236052 | Young H Shim | Emergency Medicine | 801 7th Ave, Fort Worth, TX 76104-2733 | 2011-04-04 |
| 1659699346 | Stephanie Felton | Emergency Medicine | 801 7th Ave, Fort Worth, TX 76104-2733 | 2010-05-06 |
| 1972745644 | Jennifer Gittleman | Emergency Medicine | 1108 S Henderson St, Fort Worth, TX 76104-4430 | 2009-03-27 |
| 1043460132 | Sajay P Nair | Emergency Medicine | 801 7th Ave, Fort Worth, TX 76104-2733 | 2008-09-24 |
| 1881867331 | Sanu S. Nair | Emergency Medicine | 801 7th Ave, Fort Worth, TX 76104-2733 | 2008-04-04 |
| 1639376270 | Neil Anson Evans | Emergency Medicine | 801 7th Ave, Fort Worth, TX 76104-2733 | 2007-06-28 |
| 1750586699 | Kara Ann Starnes | Emergency Medicine | 801 7th Ave, Fort Worth, TX 76104-2733 | 2007-06-20 |
| 1982809968 | Mercedes Uribe Salmassian | Emergency Medicine | 801 7th Ave, Fort Worth, TX 76104-2733 | 2007-06-19 |
| 1982809315 | Dennis James Tanner | Emergency Medicine | 801 7th Ave, Fort Worth, TX 76104-2733 | 2007-06-16 |
| 1407059561 | Geetha Malini Devdas | Emergency Medicine | 801 7th Ave, Fort Worth, TX 76104-2733 | 2007-06-07 |
| Find all providers in FORT WORTH | ||||
| City | FORT WORTH |
| Zip Code | 76177 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.