Organization Active NPI

Mid City Health Care Clinic PLLC

  • Women's Health Nurse Practitioner
  • Euless, TX
National Provider Identifier
1235919515
Registry record updated Jul 25, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Women's Health Nurse PractitionerTaxonomy code 363LW0102X
Legal business name
MID CITY HEALTH CARE CLINIC PLLC
Practice address
350 Westpark Way Ste 223
Euless, TX 76040-3758
Phone
(817) 283-4438
Fax
(817) 283-1792
NPI assigned
Oct 3, 2023
Last updated
Jul 25, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 25, 2024

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

Authorized official

Name
Vishnu Maya Upadhyay
Title
Owner
Phone
(817) 283-4438

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Women's Health Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363LW0102X Primary

Addresses

Primary practice location

350 Westpark Way Ste 223
Euless, TX 76040-3758

Mailing address

5407 Lowrie Rd
Colleyville, TX 76034

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20240103001865 TX Part B Supplier - Clinic/Group Practice 5698125649 Receives reassigned benefits from 2 practitioners
Practice locations: Euless, TX

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
45D2299729Mid City Health Care Clinic PLLC350 Westpark Way Unit 223, Euless, TX 76040Certificate of waiverFeb 25, 2028

National Provider Directory

National Provider Directory

Locations

350 Westpark Way
Ste 223
Euless, TX 76040
Phone (817) 283-4438

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1696291200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1721865600000",
    "number": "1235919515",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5407 LOWRIE RD",
            "city": "COLLEYVILLE",
            "state": "TX",
            "postal_code": "76034"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "350 WESTPARK WAY STE 223",
            "city": "EULESS",
            "state": "TX",
            "postal_code": "760403758",
            "telephone_number": "817-283-4438",
            "fax_number": "817-283-1792"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MID CITY HEALTH CARE CLINIC PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-10-03",
        "last_updated": "2024-07-25",
        "certification_date": "2024-07-18",
        "status": "A",
        "authorized_official_last_name": "MAYA UPADHYAY",
        "authorized_official_first_name": "VISHNU",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "817-283-4438"
    },
    "taxonomies": [
        {
            "code": "363LW0102X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Women's Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Euless, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 25, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.