Clinic 21 of Tarrant County, PLLC

Primary specialty

Emergency Medicine PhysicianTaxonomy code 207P00000X

Legal business name

CLINIC 21 OF TARRANT COUNTY, PLLC

Practice address

431 E. State Highway 114 Suite 120
Southlake, TX 76092-4407

Phone

(817) 251-3981

Fax

(817) 251-3245

NPI assigned

Mar 11, 2015

Organization subpart

No

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

Authorized official

Name

David C Packo, MDNPI 1497813281

Title

President

Phone

(330) 493-4443

Specialties & licenses 1

Addresses

Practitioners 1

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

• David Packo, MD

  • Emergency Medicine Physician
  • Massillon, OH
  • NPI 1497813281

  Emergency Medicine

  NPD (past) Authorized official

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

{
    "created_epoch": "1426032000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1447632000000",
    "number": "1871986109",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4535 DRESSLER RD NW",
            "city": "CANTON",
            "state": "OH",
            "postal_code": "447182545",
            "telephone_number": "330-493-4443",
            "fax_number": "330-451-4142"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "431 E. STATE HIGHWAY 114 SUITE 120",
            "city": "SOUTHLAKE",
            "state": "TX",
            "postal_code": "760924407",
            "telephone_number": "817-251-3981",
            "fax_number": "817-251-3245"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CLINIC 21 OF TARRANT COUNTY, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-03-11",
        "last_updated": "2015-11-16",
        "status": "A",
        "authorized_official_last_name": "PACKO",
        "authorized_official_first_name": "DAVID",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "330-493-4443",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Emergency Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Randall Edward Clark Jr.
• David Clay IV, DPT
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• Clifton L. Cox II M D P a
• Gabriella Clifton
• Clinical Neurosciences LLC
• Bekah Coates
• Cody L. Mihills MD PA
• Jessica Julstedt Coffee, RD, LD
• Meredith Colbert

• Emergency Medicine Physician in Southlake, TX
• Providers in Southlake, TX by specialty
• Emergency Medicine Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 16, 2015; 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.