NPI Code Detail JSON Logo

1720937295 NPI number — STRATEGIC MEDICAL GROUP TX PLLC

NPI Number: 1720937295
Health Care Provider/Practitioner: STRATEGIC MEDICAL GROUP TX PLLC

Information about “1720937295” NPI (STRATEGIC MEDICAL GROUP TX PLLC) exists in 1720937295 in HTML format HTML  |  1720937295 in plain Text format TXT  |  1720937295 in PDF (Portable Document Format) PDF  |  1720937295 in an XML format XML  formats.

NPI Number : 1720937295 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1720937295",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "STRATEGIC MEDICAL GROUP TX PLLC",
    "LastName": null,
    "FirstName": null,
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "4400 OAK PARK LN",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "FORT WORTH",
    "MailingAddressStateName": "TX",
    "MailingAddressPostalCode": "76109-9534",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "617-985-7772",
    "MailingAddressFaxNumber": "617-985-7772",
    "FirstLinePracticeLocationAddress": "909 SOUTHEAST PKWY STE 105",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "AZLE",
    "PracticeLocationAddressStateName": "TX",
    "PracticeLocationAddressPostalCode": "76020-3600",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "817-238-0735",
    "PracticeLocationAddressFaxNumber": "817-238-7327",
    "EnumerationDate": "01/27/2026",
    "LastUpdateDate": "01/27/2026",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "SELOD",
    "AuthorizedOfficialFirstName": "OMAR",
    "AuthorizedOfficialMiddleName": "F",
    "AuthorizedOfficialTitle": "OWNER",
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": "817-336-7188",
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "261QP2300X",
        "TaxonomyName": "Primary Care Clinic/Center",
        "LicenseNumber": null,
        "LicenseNumberStateCode": null,
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

Copyright © 2007-2026 Data Labs Health. All rights reserved.