Myclinic LLC

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

J4319 Issued in TX

Legal business name

MYCLINIC LLC

Doing business as

My Clinic

Practice address

2440 S Collins St
Arlington, TX 76014-1239

Phone

(214) 537-7615

NPI assigned

Feb 28, 2011

Organization subpart

No

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

Authorized official

Name

Dr. Federico Maese, MD

Title

President

Phone

(214) 537-7615

Specialties & licenses 3

Addresses

Other identifiers 3

Other names 1

• My Clinic Doing business as

Locations

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

{
    "created_epoch": "1298851200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1565568000000",
    "number": "1154628170",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2440 S COLLINS ST",
            "city": "ARLINGTON",
            "state": "TX",
            "postal_code": "760141239"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2440 S COLLINS ST",
            "city": "ARLINGTON",
            "state": "TX",
            "postal_code": "760141239",
            "telephone_number": "214-537-7615"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MYCLINIC LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-02-28",
        "last_updated": "2019-08-12",
        "status": "A",
        "authorized_official_last_name": "MAESE",
        "authorized_official_first_name": "FEDERICO",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "214-537-7615",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": "TX",
            "license": "J4319",
            "primary": true
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": "TX",
            "license": "J4319",
            "primary": false
        },
        {
            "code": "207RC0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "TX",
            "license": "J4319",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE",
            "identifier": "0067CD",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "131230801",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TEXAS STATE BOARD OF MEDICAL EXAMINERS",
            "identifier": "J4319",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "My Clinic",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "My Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Family Medicine Physician in Arlington, TX
• Providers in Arlington, TX by specialty
• Family Medicine Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 12, 2019; 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.