Provider Demographics
NPI:1871843284
Name:PEDIATRIC URGENT CARE CENTER OF NORTH TEXAS
Entity Type:Organization
Organization Name:PEDIATRIC URGENT CARE CENTER OF NORTH TEXAS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:COWAN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:817-271-4309
Mailing Address - Street 1:3400 TEXAS SAGE TRL
Mailing Address - Street 2:148
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76177-8603
Mailing Address - Country:US
Mailing Address - Phone:817-271-4309
Mailing Address - Fax:817-750-7336
Practice Address - Street 1:3400 TEXAS SAGE TRL
Practice Address - Street 2:148
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76177-8603
Practice Address - Country:US
Practice Address - Phone:817-271-4309
Practice Address - Fax:817-750-7336
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-12
Last Update Date:2012-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH9459261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care