Advanced Wound Care of North Texas PLLC
Organization Active NPI Family Medicine Physician · Dallas, TX
NPI 1366908600 · NPPES record last updated Feb 12, 2019
Key facts
- NPI
- 1366908600
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Family Medicine Physician 207Q00000X
- Legal business name
- ADVANCED WOUND CARE OF NORTH TEXAS PLLC
- Practice address
- 13154 Coit Rd Ste 102D
Dallas, TX 75240-5787 - Phone
- (956) 332-3809
- NPI assigned
- Feb 12, 2019
- Organization subpart
- No
Authorized official
- Name
- Shahida Rafiq
- Title
- Owner
- Phone
- (956) 332-3809
Practitioners 20
-
Shahida Rafiq, M.D.
-
Shauntorya Jackson, AGNP
-
Tsedey Aberra Tadesse, APRN, BC
-
Kimberley Windisch, MSN, APRN
-
Gideon Ibe Ahanonu, FNP
-
Nirmala Martin, FNP-C
-
Stacey Ann Morrow, AGACNP-BC
-
Kimberly R Neely, GNP
-
Hei Nam Cheryl Wong, FNP-C
-
Mofoluwasho Adenekan, FNP
-
Alyson Clegg, CRNP
-
Kathleen Durham Daigle, PA-C
-
Rebeca Nunez Ozyurt, PA-C
-
Jennifer Congdon, FNP-C
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in TX
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20190913000101 | TX | Part B Supplier - Clinic/Group Practice | 7315276599 |
Receives reassigned benefits from 19 practitioners Practice locations: Dallas, TX |
National Provider Directory
Locations
7300 University Hills Blvd
Ste 26
Dallas, TX 75241
Phone (972) 338-1793
13154 Coit Rd
Dallas, TX 75240
Phone (443) 235-4991
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician |
207Q00000X | Yes |
Addresses
Primary practice location
13154 Coit Rd Ste 102D
Dallas, TX 75240-5787
Mailing address
13154 Coit Rd Ste 102D
Dallas, TX 75240-5787
Phone (956) 332-3809
NPI Registry JSON
{
"created_epoch": "1549929600000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1549929600000",
"number": "1366908600",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "13154 COIT RD STE 102D",
"city": "DALLAS",
"state": "TX",
"postal_code": "752405787",
"telephone_number": "956-332-3809"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "13154 COIT RD STE 102D",
"city": "DALLAS",
"state": "TX",
"postal_code": "752405787",
"telephone_number": "956-332-3809"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "ADVANCED WOUND CARE OF NORTH TEXAS PLLC",
"organizational_subpart": "NO",
"enumeration_date": "2019-02-12",
"last_updated": "2019-02-12",
"status": "A",
"authorized_official_last_name": "RAFIQ",
"authorized_official_first_name": "SHAHIDA",
"authorized_official_title_or_position": "OWNER",
"authorized_official_telephone_number": "956-332-3809"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Family Medicine",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Dallas, TX
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All providers in Dallas, TX · Family Medicine Physician in Texas
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 12, 2019. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.