Provider Demographics
NPI:1679967145
Name:MID CITIES HEALTH LLC
Entity Type:Organization
Organization Name:MID CITIES HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR / OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SABA
Authorized Official - Middle Name:
Authorized Official - Last Name:SHABNAM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:817-776-0605
Mailing Address - Street 1:PO BOX 93329
Mailing Address - Street 2:
Mailing Address - City:SOUTHLAKE
Mailing Address - State:TX
Mailing Address - Zip Code:76092-0113
Mailing Address - Country:US
Mailing Address - Phone:817-776-0605
Mailing Address - Fax:
Practice Address - Street 1:1601 LANCASTER DR STE 160
Practice Address - Street 2:
Practice Address - City:GRAPEVINE
Practice Address - State:TX
Practice Address - Zip Code:76051-2107
Practice Address - Country:US
Practice Address - Phone:817-510-9645
Practice Address - Fax:817-685-6047
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-23
Last Update Date:2021-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM2797207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty