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1504 Pennsylvania Ave Ft Worth TX 76104-2027 | |
| (817) 335-4878 | |
| (817) 335-4890 |
| Full Name | |
|---|---|
| Speciality | Clinic/center |
| Location | 1504 Pennsylvania Ave, Ft Worth, Texas |
| Authorized Official Name and Position | Thomas Rhudy (CHIEF OF STAFF) |
| Authorized Official Contact | 2143784499 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
200 Wynnewood Village Dallas TX 75224 Ph: (214) 378-4499 | 1504 Pennsylvania Ave Ft Worth TX 76104-2027 Ph: (817) 335-4878 |
| NPI Number | 1457401135 |
|---|---|
| Provider Enumeration Date | 01/12/2007 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1457401135 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | (* (Not Available)) | Primary |
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