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General NPI Number Information
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NPI Number | 1871843284
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Entity Type | Organization
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Legal Business Name | PEDIATRIC URGENT CARE CENTER OF NORTH TEXAS
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Dates
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Enumeration Date | 09/12/2012
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Last Update Date | 09/12/2012
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Provider Practice Location Address
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Address Line | 3400 TEXAS SAGE TRL 148
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City | FORT WORTH
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State | TX
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Zip | 76177-8603
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Country | US
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Telephone | 817-271-4309
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Fax | 817-750-7336
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Provider Business Mailing Address
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Address Line | 3400 TEXAS SAGE TRL 148
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City | FORT WORTH
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State | TX
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Zip | 76177-8603
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Country | US
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Telephone | 817-271-4309
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Fax | 817-750-7336
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Authorized Official
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Title or Position | OWNER
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Name | DR. MICHAEL COWAN
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Credential | D.O.
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Telephone | 817-271-4309
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QU0200X
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Taxonomy Name | Urgent Care Clinic/Center
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License Number | H9459
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License Number State | TX
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