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

Clinic 21 of Ft Worth, LLC

Organization Emergency Medicine Physician · NPI 1700257763

Clinic 21 of Ft Worth, LLC is an Emergency Medicine Physician in Fort Worth, Texas. Registered with an NPI since 2015.

In the registry since
2015
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

5450 Clearfork Main St Ste 100
Fort Worth, TX 76109-3559
Phone: (817) 732-9372
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Emergency Medicine Physician (primary) Taxonomy 207P00000X

Record details

NPI number1700257763
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official David Packo — President · (330) 493-4443
NPI enumeratedOctober 15, 2015
Last updated in NPPESJanuary 13, 2016
Mailing address4535 Dressler Rd Nw, Canton, OH 44718-2545

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