Active NPI
Kingsley Medical Clinic, P.a.
- Family Medicine Physician
- Garland, TX
National Provider Identifier
1497876288
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- Legal business name
- KINGSLEY MEDICAL CLINIC, P.A.
- Practice address
- 219 W Kingsley Rd
Suit 336
Garland, TX 75041-3448 - Phone
- (972) 271-5544
- NPI assigned
- Apr 2, 2007
- 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
- Bruce E. Wardlay, D.O
- Title
- Owner
- Phone
- (972) 271-5544
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 |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | Primary |
Addresses
Primary practice location
219 W Kingsley Rd
Suit 336
Garland, TX 75041-3448
Mailing address
219 W Kingsley Rd
Suit 336
Garland, TX 75041-3448
Phone (972) 271-5544
Other names 1
- ridgewood medical clinic
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in TX
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040209000109 | TX | Part B Supplier - Clinic/Group Practice | 8426941899 |
Receives reassigned benefits from 8 practitioners Practice locations: Garland, TX |
National Provider Directory
National Provider DirectoryPractitioners & affiliated clinicians
Practitioners 9
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
-
- Family Medicine Physician
- Fort Worth, TX
- NPI 1992929947
Family Medicine, TX
-
- Family Medicine Physician
- Mount Dora, FL
- NPI 1720492242
Family Medicine
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1175472000000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1598054400000",
"number": "1497876288",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "219 W KINGSLEY RD",
"address_2": "SUIT 336",
"city": "GARLAND",
"state": "TX",
"postal_code": "750413448",
"telephone_number": "972-271-5544"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "219 W KINGSLEY RD",
"address_2": "SUIT 336",
"city": "GARLAND",
"state": "TX",
"postal_code": "750413448",
"telephone_number": "972-271-5544"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "KINGSLEY MEDICAL CLINIC, P.A.",
"organizational_subpart": "NO",
"enumeration_date": "2007-04-02",
"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": "972-271-5544",
"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": [
{
"organization_name": "ridgewood medical clinic",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Garland, TX
Sources for this page
- 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.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.