| Aids Outreach Center | |
|
400 North Beach Street Fort Worth TX 76111 | |
| (817) 335-1994 | |
| (817) 335-3617 |
| Full Name | Aids Outreach Center |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 400 North Beach Street, Fort Worth, Texas |
| Authorized Official Name and Position | Mellisand Le Roy (ASSOCIATE EXECUTIVE DIRECTOR) |
| Authorized Official Contact | 8173351994 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Aids Outreach Center 400 North Beach Street Fort Worth TX 76111 Ph: (817) 335-1994 | Aids Outreach Center 400 North Beach Street Fort Worth TX 76111 Ph: (817) 335-1994 |
| NPI Number | 1285761999 |
|---|---|
| Provider Enumeration Date | 02/28/2007 |
| Last Update Date | 03/30/2015 |
| Medicare PECOS PAC ID | 5991784308 |
|---|---|
| Medicare Enrollment ID | O20040719000984 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1285761999 | NPI | - | NPPES |
| 109329601 | Medicaid | TX | |
| 109329602 | Medicaid | TX | |
| TXB112740 | Other | TX | MEDICARE PTAN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | NA (Texas) | Primary |
| Provider Name | Kristen E Conner |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1588857213 PECOS PAC ID: 7214179316 Enrollment ID: I20130819000719 |
| Provider Name | Kaliah A Sami |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1811552284 PECOS PAC ID: 2062747934 Enrollment ID: I20190715002195 |
| Provider Name | Maureen Limosnero |
|---|---|
| Provider Type | Practitioner - Dentist |
| Provider Identifiers | NPI Number: 1407945876 PECOS PAC ID: 0547655276 Enrollment ID: I20220316002524 |
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