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SOUTHLAKE PHYSICAL MEDICINE PLLC
NPI 1083088900
Internal Medicine in Southlake, TX

Active since November 16, 2015CLIA 45D2123948 · Waiver
1500 W SOUTHLAKE BLVD, SUITE 120, SOUTHLAKE, TX 76092(817) 416-6116 Get Directions Write a Review

NPPES record last updated: April 29, 2016. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Southlake Physical Medicine Pllc NPPES

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

SOUTHLAKE PHYSICAL MEDICINE PLLC (NPI 1083088900) is a healthcare organization registered as an internal medicine in Southlake, Texas and active in the NPI registry since November 2015. The organization holds a CLIA Waiver certificate valid through January 4, 2027 and lists Gary Tigges, Medical Director, as its authorized official.

NPPES Registry Identity

NPI1083088900
Entity TypeOrganization
Primary Taxonomy207R00000X
Legal Business NameSOUTHLAKE PHYSICAL MEDICINE PLLC
Location Address1500 W SOUTHLAKE BLVD, SUITE 120Southlake, TX 76092-5950
Mailing Address1500 W Southlake Blvd, Suite 120Southlake, TX 76092-5950
Phone(817) 416-6116
Organization SubpartNo
Authorized OfficialGary TiggesMedical Director · (972) 981-8345
Enumeration DateNovember 16, 2015
Last NPPES UpdateApril 29, 2016
✔ NPI 1083088900 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyInternal MedicineAllopathic & Osteopathic Physicians
Taxonomy Code207R00000X
Definition
A physician who provides long-term, comprehensive care in the office and the hospital, managing both common and complex illness of adolescents, adults and the elderly. Internists are trained in the diagnosis and treatment of cancer, infections and diseases affecting the heart, blood, kidneys, joints and digestive, respiratory and vascular systems. They are also trained in the essentials of primary care internal medicine, which incorporates an understanding of disease prevention, wellness, substance abuse, mental health and effective treatment of common problems of the eyes, ears, skin, nervous system and reproductive organs.
1500 W SOUTHLAKE BLVD, Southlake, TX 76092
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Group Practice 1

Group TaxonomyThis provider is a business group of one or more individual practitioners, who practice with different areas of specialization.193200000X MULTI-SPECIALTY GROUP

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Ambetter from Arizona Complete Health, Ambetter from Arkansas Health & Wellness, Ambetter from Louisiana Healthcare Connections and more.Insurance ›

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 45D2123948

Southlake Physical Medicine, PLLC · Southlake, TX
Active · expires Jan 4, 2027
CLIA Number45D2123948
Laboratory TypePractitioner Other
Certificate Effective DateJanuary 5, 2025
Certificate Expiration DateJanuary 4, 2027
Laboratory DirectorGary A. Tiggs
Laboratory Phone(817) 898-7400
Laboratory LocationSouthlake Physical Medicine, PLLC1500 W Southlake Blvd # 120, Southlake, TX 76092
CLIA data matches this NPI record on: Address Name
This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES 6

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

DR. DEREK RICHARD HERMS DC
Chiropractor
1500 W SOUTHLAKE BLVD, SUITE 120
SOUTHLAKE, TX 76092
Tarrant County (817) 416-6116
MR. BILL CHANIN HUBBS AGACNP
Nurse Practitioner (Acute Care)
1500 W SOUTHLAKE BLVD, STE #120
SOUTHLAKE, TX 76092
Tarrant County (817) 416-6116
CHIROPRACTIC CARE CENTER OF SOUTHLAKE, P.C.
Chiropractor
1500 W SOUTHLAKE BLVD, SUITE 120
SOUTHLAKE, TX 76092
Tarrant County (817) 416-6116
MR. PAUL C PO CHING JR.
Psychologist
1500 W SOUTHLAKE BLVD
SOUTHLAKE, TX 76092
Tarrant County (757) 528-0558
DR. TYCE D HERGERT D.C.
Chiropractor
1500 W SOUTHLAKE BLVD, SUITE 120
SOUTHLAKE, TX 76092
Tarrant County (817) 416-6116
HWA TOW ACUPUNCTURE AND ORIENTAL MEDICINE INC.
Acupuncturist
1500 W SOUTHLAKE BLVD, STE 180
SOUTHLAKE, TX 76092
Tarrant County (817) 488-9613

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 Southlake Physical Medicine PLLC's NPI number?

The NPI number for Southlake Physical Medicine PLLC is 1083088900. It was assigned to this organization in the NPPES registry on November 16, 2015.

Where is Southlake Physical Medicine PLLC located?

Southlake Physical Medicine PLLC is located at 1500 W Southlake Blvd Suite 120, Southlake, TX 76092. The listed phone number is (817) 416-6116.

What is Southlake Physical Medicine PLLC's specialty?

The primary specialty registered for this NPI is Internal Medicine with taxonomy code 207R00000X.

Does Southlake Physical Medicine PLLC hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 45D2123948) is associated with this NPI, valid through January 4, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

What insurance does Southlake Physical Medicine PLLC accept?

Health plans from Ambetter from Arizona Complete Health, Ambetter from Arkansas Health & Wellness, Ambetter from Louisiana Healthcare Connections, Ambetter from Superior HealthPlan and Ambetter of Oklahoma and 3 other insurers list Southlake Physical Medicine PLLC as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Southlake Physical Medicine PLLC was last updated on April 29, 2016. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 10 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.