NPIMap

Organization Active NPI

Advanced Wound Care of North Texas PLLC

  • Family Medicine Physician
  • Dallas, TX
National Provider Identifier
1366908600
Registry record updated Feb 12, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 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
Last updated
Feb 12, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 12, 2019

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

Authorized official

Name
Shahida RafiqNPI 1134165988
Title
Owner
Phone
(956) 332-3809

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)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X Primary

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

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20190913000101 TX Part B Supplier - Clinic/Group Practice 7315276599 Receives reassigned benefits from 19 practitioners
Practice locations: Dallas, TX

National Provider Directory

National Provider Directory

Locations

7300 University Hills Blvd
Ste 26
Dallas, TX 75241
Phone (972) 338-1793

3430 Camp Bowie Blvd
Fl 1
Fort Worth, TX 76107
Phone (817) 735-5051

Practitioners & affiliated clinicians

Practitioners 20

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.

View all 20

NPI Registry JSON

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

{
    "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

Sources for this page

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

Verify at the official NPI Registry.