Emcc Azle Family Practice LLC

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

EMCC AZLE FAMILY PRACTICE LLC

Practice address

601 Northwest Pkwy Ste C
Azle, TX 76020-2930

Phone

(817) 270-0788

NPI assigned

Feb 12, 2019

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Michelle Newsom

Title

VP of Operations

Phone

(817) 271-2583

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1549929600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1684368000000",
    "number": "1104382340",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2300 MATLOCK RD STE 35",
            "city": "MANSFIELD",
            "state": "TX",
            "postal_code": "760635018",
            "telephone_number": "469-830-8200",
            "fax_number": "469-830-8201"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "601 NORTHWEST PKWY STE C",
            "city": "AZLE",
            "state": "TX",
            "postal_code": "760202930",
            "telephone_number": "817-270-0788"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EMCC AZLE FAMILY PRACTICE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-02-12",
        "last_updated": "2023-05-18",
        "certification_date": "2023-05-18",
        "status": "A",
        "authorized_official_last_name": "NEWSOM",
        "authorized_official_first_name": "MICHELLE",
        "authorized_official_title_or_position": "VP OF OPERATIONS",
        "authorized_official_telephone_number": "817-271-2583"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• All providers in Azle, TX
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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 18, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.