Active NPI
Medpeds Medical Clinic, PA
- Internal Medicine Physician
- Weatherford, TX
National Provider Identifier
1548501901
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Internal Medicine Physician
- License
- M5284
- Legal business name
- MEDPEDS MEDICAL CLINIC, PA
- Practice address
- 2111 Fort Worth Hwy
Weatherford, TX 76086-4834 - Phone
- (817) 596-3700
- Fax
- (866) 883-0041
- NPI assigned
- Mar 11, 2013
- 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
- Dr. Nusrat A Khan, MD
- Title
- Medical Director
- Phone
- (817) 596-3700
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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | M5284 | TX | Primary |
| Pediatrics Physician | 208000000X | M5284 | TX |
Addresses
Primary practice location
2111 Fort Worth Hwy
Weatherford, TX 76086-4834
Mailing address
PO Box 1479
Weatherford, TX 76086-1479
Phone (817) 596-3700
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2176489-02 | Medicaid | TX | |
| 2176489-01 | Medicaid | TX |
National Provider Directory
National Provider DirectoryLocations
2111 Fort Worth Hwy
Weatherford, TX 76086
Phone (817) 596-3700
Practitioners & affiliated clinicians
Practitioners 1
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
-
- Internal Medicine Physician
- Willow Park, TX
- NPI 1316053408
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1362960000000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1362960000000",
"number": "1548501901",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 1479",
"city": "WEATHERFORD",
"state": "TX",
"postal_code": "760861479",
"telephone_number": "817-596-3700",
"fax_number": "866-883-0041"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2111 FORT WORTH HWY",
"city": "WEATHERFORD",
"state": "TX",
"postal_code": "760864834",
"telephone_number": "817-596-3700",
"fax_number": "866-883-0041"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "MEDPEDS MEDICAL CLINIC, PA",
"organizational_subpart": "NO",
"enumeration_date": "2013-03-11",
"last_updated": "2013-03-11",
"status": "A",
"authorized_official_last_name": "KHAN",
"authorized_official_first_name": "NUSRAT",
"authorized_official_middle_name": "A",
"authorized_official_title_or_position": "MEDICAL DIRECTOR",
"authorized_official_telephone_number": "817-596-3700",
"authorized_official_name_prefix": "Dr.",
"authorized_official_credential": "MD"
},
"taxonomies": [
{
"code": "207R00000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Internal Medicine",
"state": "TX",
"license": "M5284",
"primary": true
},
{
"code": "208000000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Pediatrics",
"state": "TX",
"license": "M5284",
"primary": false
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "2176489-02",
"state": "TX"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "2176489-01",
"state": "TX"
}
],
"endpoints": [],
"other_names": []
}Other providers in Weatherford, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 11, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.