Provider Demographics
NPI:1871279455
Name:STRATEGIC MEDICAL GROUP TX PLLC
Entity type:Organization
Organization Name:STRATEGIC MEDICAL GROUP TX PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:OMAR
Authorized Official - Middle Name:F
Authorized Official - Last Name:SELOD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:817-336-7188
Mailing Address - Street 1:7101 BRYANT IRVIN RD # 33292
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76132-4135
Mailing Address - Country:US
Mailing Address - Phone:817-721-3145
Mailing Address - Fax:813-538-7880
Practice Address - Street 1:6100 HARRIS PKWY STE 1240
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76132-4248
Practice Address - Country:US
Practice Address - Phone:817-433-5155
Practice Address - Fax:817-433-5177
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:STRATEGIC MEDICAL GROUP TX PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-06-27
Last Update Date:2023-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care