Clinic 21 of Tarrant County, Pllc

NPI #1871986109 in Southlake, Texas

Provider Information

NPI Number: 1871986109
Entity Type: Organization
Organization Name: Clinic 21 of Tarrant County, Pllc
Primary Specialty: Emergency Medicine
Enumeration Date: Mar 11, 2015
Last Updated: Nov 16, 2015

Practice Location

Address: 431 E. STATE HIGHWAY 114 SUITE 120
City: Southlake
State: Texas
ZIP Code: 76092-4407
Phone: (817) 251-3981

Authorized Official

Name: DAVID C PACKO, MD
Title: PRESIDENT
Phone: (330) 493-4443

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Emergency Medicine	207P00000X	Primary

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