Provider Demographics
NPI:1083162093
Name:WELL CREST MEDICAL CLINIC PLLC
Entity Type:Organization
Organization Name:WELL CREST MEDICAL CLINIC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MEENU
Authorized Official - Middle Name:
Authorized Official - Last Name:SHARMA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:817-615-8627
Mailing Address - Street 1:13000 BELLA ITALIA CT
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76126-6106
Mailing Address - Country:US
Mailing Address - Phone:817-615-8627
Mailing Address - Fax:817-615-8574
Practice Address - Street 1:11803 SOUTH FWY STE 205
Practice Address - Street 2:
Practice Address - City:BURLESON
Practice Address - State:TX
Practice Address - Zip Code:76028-7030
Practice Address - Country:US
Practice Address - Phone:817-615-8627
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-19
Last Update Date:2016-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty