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EXECUTIVE MEDICINE OF TEXAS
NPI 1043720154
Family Medicine in Southlake, TX

Active since October 03, 2017CLIA 45D1037921 · Waiver
2106 E STATE HIGHWAY 114, STE 300, SOUTHLAKE, TX 76092(817) 552-4300 Get Directions Write a Review

NPPES record last updated: October 3, 2017. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Executive Medicine Of Texas NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

EXECUTIVE MEDICINE OF TEXAS (NPI 1043720154) is a healthcare organization registered as a family medicine in Southlake, Texas and active in the NPI registry since October 2017. The organization holds a CLIA Waiver certificate valid through October 28, 2027 and lists Walter Gaman, Physician/partner, as its authorized official.

NPPES Registry Identity

NPI1043720154
Entity TypeOrganization
Primary Taxonomy207Q00000X
Legal Business NameHEALTHCARE ASSOCIATES OF SOUTHLAKE LLP
Location Address2106 E STATE HIGHWAY 114, STE 300Southlake, TX 76092
Mailing Address2106 E State Highway 114, Ste 300Southlake, TX 76092 · (817) 552-4300
Phone(817) 552-4300
Organization SubpartNo
Authorized OfficialWalter GamanPhysician/partner · (817) 307-9312
Enumeration DateOctober 3, 2017
✔ NPI 1043720154 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyFamily MedicineAllopathic & Osteopathic Physicians
Taxonomy Code207Q00000X
Definition
Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity.
2106 E STATE HIGHWAY 114, Southlake, TX 76092
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Other Names 1

Doing Business AsExecutive Medicine Of Texas

Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 45D1037921

Executive Medicine Of Southlake · Southlake, TX
Active · expires Oct 28, 2027
CLIA Number45D1037921
Laboratory TypePhysician Office
Certificate Effective DateOctober 29, 2025
Certificate Expiration DateOctober 28, 2027
Laboratory DirectorWalter N. Gaman
Laboratory Phone(817) 552-4300
Laboratory LocationExecutive Medicine Of Southlake2106 E State Highway 114 Suite 300, Southlake, TX 76092
CLIA data matches this NPI record on: Address Phone
This certificate is issued to a laboratory to perform only waived tests.

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Healthcare Associates Of Southlake LLP's NPI number?

The NPI number for Healthcare Associates Of Southlake LLP is 1043720154. It was assigned to this organization in the NPPES registry on October 3, 2017. The provider is doing business as Executive Medicine Of Texas.

Where is Healthcare Associates Of Southlake LLP located?

Healthcare Associates Of Southlake LLP is located at 2106 E State Highway 114 Ste 300, Southlake, TX 76092. The listed phone number is (817) 552-4300.

What is Healthcare Associates Of Southlake LLP's specialty?

The primary specialty registered for this NPI is Family Medicine with taxonomy code 207Q00000X.

Does Healthcare Associates Of Southlake LLP hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 45D1037921) is associated with this NPI, valid through October 28, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Healthcare Associates Of Southlake LLP was last updated on October 3, 2017. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 8 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.