| Fort Worth Medical Specialists Pllc | |
|
724 Pennsylvania Ave Fort Worth TX 76104-2221 | |
| (817) 336-1200 | |
| Not Available |
| Full Name | Fort Worth Medical Specialists Pllc |
|---|---|
| Speciality | Internal Medicine |
| Location | 724 Pennsylvania Ave, Fort Worth, Texas |
| Authorized Official Name and Position | Gregory Joseph Phillips (OWNER) |
| Authorized Official Contact | 8173361200 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Fort Worth Medical Specialists Pllc 724 Pennsylvania Ave Fort Worth TX 76104-2221 Ph: (817) 336-1200 | Fort Worth Medical Specialists Pllc 724 Pennsylvania Ave Fort Worth TX 76104-2221 Ph: (817) 336-1200 |
| NPI Number | 1417362427 |
|---|---|
| Provider Enumeration Date | 06/27/2014 |
| Last Update Date | 12/28/2018 |
| Medicare PECOS PAC ID | 2668797952 |
|---|---|
| Medicare Enrollment ID | O20150209000502 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1417362427 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (* (Not Available)) | Primary |
| Provider Name | Robert T Keller |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1962445346 PECOS PAC ID: 9739173394 Enrollment ID: I20040414001380 |
| Provider Name | Gregory Joseph Phillips |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1699705152 PECOS PAC ID: 6406986561 Enrollment ID: I20100616000440 |
| Provider Name | Rebecca N Wolverton |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1063870087 PECOS PAC ID: 4587952114 Enrollment ID: I20161013001082 |
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