NORTSIDE MEDICAL CLINIC, P.A. (NPI# 1285755504) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1285755504 |
| Entity Type | Organization |
| Organization Name | NORTSIDE MEDICAL CLINIC, P.A. |
| Practice Address |
1600 25th Street Suite B Fort Worth TX 76106 |
| Practice Telephone | 8176263434 |
| Mailing Telephone | 8176263434 |
| Enumeration Date | 2007-04-03 |
| Last Update Date | 2020-08-22 |
| Authorized Official Name | BRUCE E. WARDLAY (OWNER) |
| Authorized Official Telephone | 8176263434 |
| Authorized Official Credential | D.O. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207Q00000X | Family Medicine | Allopathic & Osteopathic Physicians |
| Street Address |
1600 25TH STREET SUITE B |
| City | FORT WORTH |
| State | TX |
| Zip Code | 76106 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1215380985 | Irene Robyn Winnett | Counselor | 2907 Loving Ave, Fort Worth, TX 76106 | 2016-07-19 |
| 1568875706 | Valerie Freeman Biegon | Contractor | A La Mod Salon/ Vfb-lmt, 3900 Merrett Drive Suite B, Lake Worth, TX 76106 | 2014-06-05 |
| 1659555738 | Northside Adult Daycare Center, Inc. | Clinic/Center | 1401 Clinton Ave, Fort Worth, TX 76106 | 2007-12-24 |
| 1477607240 | H Pena Md North Main Medical and Surgical Clinic Assoc | General Practice | 3301 North Main Street, Fort Worth, TX 76106 | 2007-01-22 |
| 1093800153 | Jinat Corporation | Dentist | 1612 Nw 28th St, Fort Worth, TX 76106 | 2006-10-04 |
| 1568751006 | Elizabeth Rivera | Family Medicine | 3308 Deen Rd, Fort Worth, TX 76106 | 2011-04-05 |
| 1104156173 | Katherine Courtney Thompson | Speech-Language Pathologist | 3600 Angle Ave, Fort Worth, TX 76106 | 2010-01-13 |
| 1417066507 | Priyanka Kandhari | Dentist | 3308 Deen Rd, Fort Worth, TX 76106 | 2006-08-30 |
| 1417518648 | Kristina Lahti | Occupational Therapist | 4775 North Fwy, Fort Worth, TX 76106-2315 | 2019-06-27 |
| 1538773072 | Michael David Castillon | Behavior Technician | 4775 North Fwy, Fort Worth, TX 76106-2315 | 2020-09-02 |
| Find all providers in zip 76106 | ||||
| Taxonomy Code | 207Q00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Family Medicine |
| Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. |
| Notes: Source: American Board of Family Medicine [1/1/2007: changed title; 7/1/2007: added definition, added source; 7/1/2017: modified definition] - Note: The American Osteopathic Board of Family Physicians certification includes extensive use of Osteopathic Manipulative Treatment (OMT), which integrates the biological, clinical, and behavioral sciences. - Additional Resources: American Board of Family Medicine, www.theabfm.org. American Osteopathic Board of Family Physicians, www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Family Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Family Physicians or the American Board of Family Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1770184020 | Kara Fenceroy | Family Medicine | 5425 Rolling Meadows Dr, Fort Worth, TX 76123-2836 | 2020-11-03 |
| 1003416207 | Adeline Galvez | Family Medicine | 1300 W Terrell Ave Ste 270, Fort Worth, TX 76104-2820 | 2020-10-27 |
| 1952870354 | Nancy Carolina Nicoloso | Family Medicine | 6302 Lake Worth Blvd Ste A3963, Fort Worth, TX 76135-3607 | 2018-11-15 |
| 1245717586 | Julia Dubose | Family Medicine | 4100 Heritage Trace Pkwy Ste 116, Fort Worth, TX 76244 | 2018-07-19 |
| 1609307115 | Yara Hamade Gonzales | Family Medicine | 4701 Bryant Irvin Rd, Fort Worth, TX 76132-3603 | 2017-03-26 |
| 1558732321 | Andres Morgado Perez | Family Medicine | 1325 Pennsylvania Ave Ste 750, Fort Worth, TX 76104-2168 | 2015-10-19 |
| 1114304805 | Davis Wellness Ltd LLP | Family Medicine | 3750 S. University Dr., Suite 201, Fort Worth, TX 76109-3701 | 2015-05-01 |
| 1902298417 | Jack Lynwood Judson, Md | Family Medicine | 1800 Malibar Rd, Fort Worth, TX 76116-1834 | 2015-02-21 |
| 1104243468 | Henry Dollahite | Family Medicine | 6205 Locke Ave, Fort Worth, TX 76116-4636 | 2014-03-25 |
| 1447676689 | Janet Shackelford | Family Medicine | 5001 Golden Triangle Blvd, # 1024, Fort Worth, TX 76244 | 2014-03-12 |
| Find all providers in FORT WORTH | ||||
| City | FORT WORTH |
| Zip Code | 76106 |
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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.