# EMCC AZLE FAMILY PRACTICE LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1104382340
- **Authorized official:** MICHELLE NEWSOM (VP OF OPERATIONS)
- **Authorized official phone:** (817) 271-2583

## Contact information

- **Practice address:** 601 NORTHWEST PKWY STE C, AZLE, TX 76020-2930
- **Practice address phone:** (817) 270-0788
- **Mailing address:** 2300 MATLOCK RD STE 35, MANSFIELD, TX 76063-5018
- **Mailing address phone:** (469) 830-8200
- **Mailing address fax:** (469) 830-8201

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |

## Other

- **Enumeration date:** 02/12/2019
- **Last updated:** 05/18/2023