Provider Demographics
NPI:1235919515
Name:MID CITY HEALTH CARE CLINIC PLLC
Entity Type:Organization
Organization Name:MID CITY HEALTH CARE CLINIC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:VISHNU
Authorized Official - Middle Name:
Authorized Official - Last Name:MAYA UPADHYAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-283-4438
Mailing Address - Street 1:475 FENWICK DR
Mailing Address - Street 2:
Mailing Address - City:SUNNYVALE
Mailing Address - State:TX
Mailing Address - Zip Code:75182-3223
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:350 WESTPARK WAY STE 223
Practice Address - Street 2:
Practice Address - City:EULESS
Practice Address - State:TX
Practice Address - Zip Code:76040-3758
Practice Address - Country:US
Practice Address - Phone:817-283-4438
Practice Address - Fax:817-283-1792
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-03
Last Update Date:2023-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's HealthGroup - Multi-Specialty