| Children Medicaid Clinic | |
|
11751 Alta Vista Rd Suite 103 Fort Worth TX 76244-6407 | |
| (817) 623-2012 | |
| (817) 623-2009 |
| Full Name | Children Medicaid Clinic |
|---|---|
| Speciality | Family Medicine |
| Location | 11751 Alta Vista Rd, Fort Worth, Texas |
| Authorized Official Name and Position | Navjot Bajwa (PROVIDER) |
| Authorized Official Contact | 8176232012 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Children Medicaid Clinic 11751 Alta Vista Rd Suite 103 Fort Worth TX 76244-6407 Ph: (817) 623-2012 | Children Medicaid Clinic 11751 Alta Vista Rd Suite 103 Fort Worth TX 76244-6407 Ph: (817) 623-2012 |
| NPI Number | 1881913028 |
|---|---|
| Provider Enumeration Date | 05/27/2010 |
| Last Update Date | 09/04/2014 |
| Medicare PECOS PAC ID | 5698951309 |
|---|---|
| Medicare Enrollment ID | O20110513000550 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1881913028 | NPI | - | NPPES |
| 281353701 | Medicaid | TX | |
| 281353702 | Other | MEDICAID EP1 |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | K5790 (Texas) | Primary |
| Provider Name | Navjot Bajwa |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1487604567 PECOS PAC ID: 3476568924 Enrollment ID: I20101228000437 |
| Provider Name | Maheswari Raja |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1548349814 PECOS PAC ID: 9032117981 Enrollment ID: I20110506000230 |
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