Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

CC1 Medical Holding LLC

Organization Electrodiagnostic Medicine Physician · NPI 1093423535

CC1 Medical Holding LLC is an Electrodiagnostic Medicine Physician in Ft Worth, Texas. Registered with an NPI since 2022.

In the registry since
2022
What do these letters mean?
LLC — Limited liability company
A form of business registration, not a clinical qualification.

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Practice location Address checks out

111 Boland St Ste 211
Ft Worth, TX 76107-1265
Phone: (817) 529-8488
Fax: (903) 328-6568
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Electrodiagnostic Medicine Physician (primary) Taxonomy 204R00000X

Record details

NPI number1093423535
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Gina Sullivan — Practice Administrators · (903) 259-0550
NPI enumeratedNovember 14, 2022
Last updated in NPPESNovember 14, 2022
Certification dateNovember 14, 2022
Mailing address111 Boland St Ste 211, Ft Worth, TX 76107-1265

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