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Export Provider Record NPI 1083088900
Southlake Physical Medicine Pllc
Organization Subpart: NO
Active
NPI Number1083088900
NPI TypeNPI-2 Organization
SpecialtyInternal Medicine
Provider Details
NPI1083088900
NPI TypeNPI-2 Organization
StatusActive
Enumeration Date2015-11-16
Last Updated2016-04-29
Authorized OfficialGary Tigges
Medical Director
Phone: 9729818345
Mailing Address1500 W Southlake Blvd, Suite 120
Southlake, TX 76092-5950
United States
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Primary Practice Address1500 W Southlake Blvd, Suite 120
Southlake, TX 76092-5950
United States
Phone: (817) 416-6116
📍 View Map
Taxonomy / Specialty
PrimaryTaxonomy Code & DescriptionStateLicense Number
Yes207R00000X – Internal Medicine
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About NPI 1083088900

Southlake Physical Medicine Pllc is an organization registered in the CMS NPPES NPI Registry with NPI number 1083088900. The primary specialty listed is Internal Medicine. The organization is located in Southlake, TX. This NPI is classified as a Type 2 (Organizational) NPI and is currently active. The NPI was first enumerated (assigned) on 2015-11-16. All data is sourced directly from the official CMS NPPES public API and is updated daily.

Frequently Asked Questions

What is NPI 1083088900?

NPI 1083088900 belongs to Southlake Physical Medicine Pllc, a Internal Medicine in Southlake, TX. It is a Type 2 Organizational NPI registered in the CMS NPPES NPI Registry.

Is NPI 1083088900 active?

The current status of NPI 1083088900 in the NPPES registry is Active. The record was last updated on 2016-04-29.

What specialty is NPI 1083088900?

NPI 1083088900 is classified under the taxonomy Internal Medicine. Taxonomy codes in NPPES are maintained by the National Uniform Claim Committee (NUCC) and identify the provider's type, classification, and specialization.

How do I verify NPI 1083088900?

You can verify NPI 1083088900 at the official CMS NPPES website at npiregistry.cms.hhs.gov or using our free NPI Lookup tool above. All data shown on this page is sourced directly from the official NPPES public API and is updated daily by CMS.

What address is on file for NPI 1083088900?

The primary practice address on file for NPI 1083088900 is 1500 W Southlake Blvd, Southlake, TX 76092-5950. This address is registered in the NPPES system and providers are required to update it within 30 days of any change.

When was NPI 1083088900 issued?

NPI 1083088900 was first issued (enumerated) on 2015-11-16. The NPPES record was last updated on 2016-04-29.

Practice Location Map

Southlake Physical Medicine Pllc is located at 1500 W Southlake Blvd, Southlake, TX. Use the map below to find directions or verify the practice location.

📍 1500 W Southlake Blvd, Southlake, TX 76092-5950  ·  Open in Google Maps ↗

Related Healthcare Providers

The following providers share the same practice location, specialty, or state as Southlake Physical Medicine Pllc. All records sourced from the CMS NPPES registry.

Data Verified from CMS NPPES Last synced: 2026-06-21 · Source: npiregistry.cms.hhs.gov · 45 CFR Part 162