| Dfw Family Clinic | |
|
2771 Sherman St Grand Prairie TX 75051-6016 | |
| (972) 647-0550 | |
| (972) 647-1010 |
| Full Name | Dfw Family Clinic |
|---|---|
| Speciality | Family Medicine |
| Location | 2771 Sherman St, Grand Prairie, Texas |
| Authorized Official Name and Position | Adila Nighat Siddiqi (OWNER) |
| Authorized Official Contact | 9726470550 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Dfw Family Clinic 2771 Sherman St Grand Prairie TX 75051-6016 Ph: (972) 647-0550 | Dfw Family Clinic 2771 Sherman St Grand Prairie TX 75051-6016 Ph: (972) 647-0550 |
| NPI Number | 1811228851 |
|---|---|
| Provider Enumeration Date | 01/14/2010 |
| Last Update Date | 04/23/2014 |
| Medicare PECOS PAC ID | 7416091772 |
|---|---|
| Medicare Enrollment ID | O20100224000638 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1811228851 | NPI | - | NPPES |
| 0076EC | Other | TX | BLUE CROSS BLUE SHIELD OF TEXAS |
| OA5881 | Other | MEDICARE GROUP PTAN # | |
| 121398502 | Medicaid | TX |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | K7396 (Texas) | Primary |
| Provider Name | Adila N Siddiqi |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1932180296 PECOS PAC ID: 4183714611 Enrollment ID: I20071220000104 |
| Provider Name | Farah Siddiqi |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1619378494 PECOS PAC ID: 3678875952 Enrollment ID: I20160104000793 |
| Provider Name | Amanda Hayes |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1073230025 PECOS PAC ID: 4587023593 Enrollment ID: I20230710001338 |
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