MEDICARE: GRAND PRAIRIE URGENT CARE 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	261QU0200X	Urgent Care Clinic/Center

General Provider Information

NPI Number	:	1568187235
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GRAND PRAIRIE URGENT CARE PLLC

Provider Business Mailing Address
First Line	:	5204 S HWY 360 STE 400
Second Line	:
City	:	GRAND PRAIRIE
State	:	TX
Zip	:	75052-0947
Country	:	US
Telephone Number	:	972-971-7945
Fax Number	:	972-602-4522

Provider Business Practice Location Address
First Line	:	5204 S HWY 360 STE 400
Second Line	:
City	:	GRAND PRAIRIE
State	:	TX
Zip	:	75052-0947
Country	:	US
Telephone Number	:	972-755-1785
Fax Number	:	972-602-4522

Authorized Official
Title or Position	:	MEDICAL DIRECTOR
Name	:	DR. SIREESHA JANGA
Credential	:	MD
Telephone Number	:	972-755-1758

Provider Enumeration Date	:	10/05/2022
Last Update Date	:	10/05/2022

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