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General NPI Number Information
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NPI Number | 1295574549
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Entity Type | Organization
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Legal Business Name | STRATEGIC MEDICAL GROUP TX PLLC
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Dates
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Enumeration Date | 05/24/2024
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Last Update Date | 05/24/2024
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Provider Practice Location Address
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Address Line | 4045 E BELKNAP ST STE 12
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City | HALTOM CITY
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State | TX
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Zip | 76111-6637
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Country | US
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Telephone | 817-759-2315
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Fax |
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Provider Business Mailing Address
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Address Line | 4400 OAK PARK LN
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City | FORT WORTH
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State | TX
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Zip | 76109-9534
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Country | US
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Telephone | 817-985-7772
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | OMAR F SELOD
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Credential |
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Telephone | 817-336-7188
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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