Nortside Medical Clinic, P.a.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

NORTSIDE MEDICAL CLINIC, P.A.

Practice address

1600 25TH Street
Suite B
Fort Worth, TX 76106

Phone

(817) 626-3434

NPI assigned

Apr 3, 2007

Organization subpart

No

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

Authorized official

Name

Bruce E. Wardlay, D.O.

Title

Owner

Phone

(817) 626-3434

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1175558400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1285755504",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1600 25TH STREET",
            "address_2": "SUITE B",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "76106",
            "telephone_number": "817-626-3434"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1600 25TH STREET",
            "address_2": "SUITE B",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "76106",
            "telephone_number": "817-626-3434"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTSIDE MEDICAL CLINIC, P.A.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-03",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "WARDLAY",
        "authorized_official_first_name": "BRUCE",
        "authorized_official_middle_name": "E.",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "817-626-3434",
        "authorized_official_credential": "D.O."
    },
    "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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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.