Ativa Health Center LLC

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

ATIVA HEALTH CENTER LLC

Practice address

3510 E Lancaster Ave
Suite B
Fort Worth, TX 76103-2555

Phone

(817) 536-0219

Fax

(817) 536-0311

NPI assigned

Aug 31, 2010

Organization subpart

No

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

Authorized official

Name

Ms. Yulia Polikhova

Title

Owner

Phone

(817) 536-0219

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1283212800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1283212800000",
    "number": "1659688406",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3510 E LANCASTER AVE",
            "address_2": "SUITE B",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761032555",
            "telephone_number": "817-536-0219",
            "fax_number": "817-536-0311"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3510 E LANCASTER AVE",
            "address_2": "SUITE B",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761032555",
            "telephone_number": "817-536-0219",
            "fax_number": "817-536-0311"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ATIVA HEALTH CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-08-31",
        "last_updated": "2010-08-31",
        "status": "A",
        "authorized_official_last_name": "POLIKHOVA",
        "authorized_official_first_name": "YULIA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "817-536-0219",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Jessica Lindsay Atkins, LSSP
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• Family Medicine Physician in Fort Worth, TX
• Providers in Fort Worth, TX by specialty
• Family Medicine Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 31, 2010; 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.