| Mid Cities Health Llc | |
|
1601 Lancaster Dr Ste 160 Grapevine TX 76051-2107 | |
| (817) 510-9645 | |
| (817) 685-6047 |
| Full Name | Mid Cities Health Llc |
|---|---|
| Speciality | Family Medicine |
| Location | 1601 Lancaster Dr Ste 160, Grapevine, Texas |
| Authorized Official Name and Position | Saba Shabnam (MEDICAL DIRECTOR / OWNER) |
| Authorized Official Contact | 8177760605 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Mid Cities Health Llc Po Box 93329 Southlake TX 76092-0113 Ph: (817) 776-0605 | Mid Cities Health Llc 1601 Lancaster Dr Ste 160 Grapevine TX 76051-2107 Ph: (817) 510-9645 |
| NPI Number | 1679967145 |
|---|---|
| Provider Enumeration Date | 03/23/2015 |
| Last Update Date | 03/11/2021 |
| Medicare PECOS PAC ID | 1052623048 |
|---|---|
| Medicare Enrollment ID | O20150706000602 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1679967145 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | M2797 (Texas) | Primary |
| Provider Name | Kayleigh King |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1821219114 PECOS PAC ID: 4789674573 Enrollment ID: I20040513001444 |
| Provider Name | Saba Shabnam |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1225091655 PECOS PAC ID: 8921049784 Enrollment ID: I20070525000542 |
| Provider Name | Tatiana Carolina Daniel |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1487154159 PECOS PAC ID: 4688936081 Enrollment ID: I20180323000390 |
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