Organization
CLINIC 21 OF TARRANT COUNTY, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DAVID C PACKO MD (PRESIDENT)
(330) 493-4443
Entity
Organization
Contact information
Practice address
431 E. STATE HIGHWAY 114 SUITE 120, SOUTHLAKE, TX 76092-4407
(817) 251-3981
(817) 251-3245
Mailing address
4535 DRESSLER RD NW, CANTON, OH 44718-2545
(330) 493-4443
(330) 451-4142
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
—
—
Other
Enumeration date
03/11/2015
Last updated
11/16/2015
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