=====================================================
General NPI Number Information
=====================================================
NPI Number | 1386837672
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DFW URGENT CARE PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/21/2007
-----------------------------------------------------
Last Update Date | 05/15/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 500 8TH AVE SUITE 110
-----------------------------------------------------
City | FORT WORTH
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76104-2065
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 817-938-0965
-----------------------------------------------------
Fax | 866-827-4104
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 500 8TH AVE SUITE 110
-----------------------------------------------------
City | FORT WORTH
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76104-2065
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 817-938-0965
-----------------------------------------------------
Fax | 866-827-4104
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MANAGING PARTNER
-----------------------------------------------------
Name | JEFFREY EMERY STERLING
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 817-938-0965
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QU0200X
-----------------------------------------------------
Taxonomy Name | Urgent Care Clinic/Center
-----------------------------------------------------
License Number | L7892
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------