Active NPI
Tri Cities Urgent Care PLLC
- Urgent Care Clinic/Center
- Willow Park, TX
National Provider Identifier
1235449752
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Urgent Care Clinic/Center
- License
- K8777
- Legal business name
- TRI CITIES URGENT CARE PLLC
- Practice address
- 123 S. Ranch House Rd
Willow Park, TX 76008-2649 - Phone
- (817) 984-7120
- Fax
- (817) 984-7121
- NPI assigned
- Oct 18, 2010
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Nadeem A Khan, M.D.
- Title
- Owner
- Phone
- (817) 984-7120
Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Urgent Care Clinic/Center | 261QU0200X | K8777 | TX | Primary |
Addresses
Primary practice location
123 S. Ranch House Rd
Willow Park, TX 76008-2649
Mailing address
123 S. Ranch House Rd
Willow Park, TX 76008-2649
Phone (817) 984-7120
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in TX
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20110421000019 | TX | Part B Supplier - Clinic/Group Practice | 3072798891 |
Receives reassigned benefits from 6 practitioners Practice locations: Willow Park, TX |
National Provider Directory
National Provider DirectoryPractitioners & affiliated clinicians
Practitioners 8
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
-
- Family Nurse Practitioner
- Willow Park, TX
- NPI 1467776484
-
- Emergency Medicine Physician
- Azle, TX
- NPI 1811930712
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1287360000000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1302652800000",
"number": "1235449752",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "123 S. RANCH HOUSE RD",
"city": "WILLOW PARK",
"state": "TX",
"postal_code": "760082649",
"telephone_number": "817-984-7120",
"fax_number": "817-984-7121"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "123 S. RANCH HOUSE RD",
"city": "WILLOW PARK",
"state": "TX",
"postal_code": "760082649",
"telephone_number": "817-984-7120",
"fax_number": "817-984-7121"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "TRI CITIES URGENT CARE PLLC",
"organizational_subpart": "NO",
"enumeration_date": "2010-10-18",
"last_updated": "2011-04-13",
"status": "A",
"authorized_official_last_name": "KHAN",
"authorized_official_first_name": "NADEEM",
"authorized_official_middle_name": "A",
"authorized_official_title_or_position": "OWNER",
"authorized_official_telephone_number": "817-984-7120",
"authorized_official_credential": "M.D."
},
"taxonomies": [
{
"code": "261QU0200X",
"taxonomy_group": "",
"desc": "Clinic/Center, Urgent Care",
"state": "TX",
"license": "K8777",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Willow Park, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 13, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.