MEDICARE: ER OF WATAUGA PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QE0002X	Emergency Care Clinic/Center

General Provider Information

NPI Number	:	1467025676
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ER OF WATAUGA PLLC

Provider Business Mailing Address
First Line	:	5401 BASSWOOD BLVD
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76137-6909
Country	:	US
Telephone Number	:	179-455-5008
Fax Number	:	817-945-5600

Provider Business Practice Location Address
First Line	:	5401 BASSWOOD BLVD
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76137-6909
Country	:	US
Telephone Number	:	179-455-5008
Fax Number	:	817-945-5600

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. ABBAS R MIAN
Credential	:	MD
Telephone Number	:	214-906-8899

Provider Enumeration Date	:	07/24/2021
Last Update Date	:	02/27/2025

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