Parkside Family Clinic, PA

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

PARKSIDE FAMILY CLINIC, PA

Practice address

1109 E Broadway St
Cuero, TX 77954-2108

Phone

(361) 275-2800

Fax

(361) 275-8791

NPI assigned

Jan 30, 2006

Organization subpart

No

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

Authorized official

Name

Michael R McLeod, M.D.

Title

Medical Director/Owner

Phone

(361) 275-2800

Specialties & licenses 1

Addresses

Other identifiers 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Justin W Powell, D.O.

  • Pediatrics Physician
  • Hallettsville, TX
  • NPI 1487663191

  Family Medicine

  NPD

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

{
    "created_epoch": "1138579200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1297641600000",
    "number": "1689645376",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1109 E BROADWAY ST",
            "city": "CUERO",
            "state": "TX",
            "postal_code": "779542108",
            "telephone_number": "361-275-2800",
            "fax_number": "361-275-8791"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1109 E BROADWAY ST",
            "city": "CUERO",
            "state": "TX",
            "postal_code": "779542108",
            "telephone_number": "361-275-2800",
            "fax_number": "361-275-8791"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PARKSIDE FAMILY CLINIC, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-01-30",
        "last_updated": "2011-02-14",
        "status": "A",
        "authorized_official_last_name": "MCLEOD",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR/OWNER",
        "authorized_official_telephone_number": "361-275-2800",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "164281101",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "179346502",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MCR",
            "identifier": "DB6498",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "179346501",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "164281102",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "179346503",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Justin Meisetschleager
• Susan Mims
• Tam Huu Ngo, BD, DMD
• Shane Thanhsang Nguyen
• Kimberly Niitzel, OTR/L
• David Ronald Polasek, RPH
• Misty Polasek, M.S. CCC-SLP
• Post Investments, Inc.
• Raymond R Reese, M.D.
• Renal Treatment Centers-Southeast, LP.

• All providers in Cuero, TX
• Family Medicine Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 14, 2011; 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.