| Fossil Creek Family Medical Center | |
|
7510 N Beach St Fort Worth TX 76137 | |
| (817) 498-1818 | |
| (817) 581-3761 |
| Full Name | Fossil Creek Family Medical Center |
|---|---|
| Speciality | Family Medicine |
| Location | 7510 N Beach St, Fort Worth, Texas |
| Authorized Official Name and Position | David Wayne Simonak (OWNER) |
| Authorized Official Contact | 8174981818 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Fossil Creek Family Medical Center 7500 N Beach St Fort Worth TX 76137-1505 Ph: (817) 498-1818 | Fossil Creek Family Medical Center 7510 N Beach St Fort Worth TX 76137 Ph: (817) 498-1818 |
| NPI Number | 1639267982 |
|---|---|
| Provider Enumeration Date | 10/11/2006 |
| Last Update Date | 03/15/2019 |
| Medicare PECOS PAC ID | 8224001268 |
|---|---|
| Medicare Enrollment ID | O20040817001211 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1639267982 | NPI | - | NPPES |
| 121142701 | Medicaid | TX |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | David W Simonak |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1093735151 PECOS PAC ID: 3072611250 Enrollment ID: I20100913000465 |
| Provider Name | Robin Rae Sustala |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1174575658 PECOS PAC ID: 9436103595 Enrollment ID: I20131119000962 |
| Provider Name | Ryan D Simonak |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1871721993 PECOS PAC ID: 5890979272 Enrollment ID: I20150909000422 |
| Provider Name | Timothy R Hawley |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1720458896 PECOS PAC ID: 0749571958 Enrollment ID: I20160620000204 |
| Provider Name | Brady Simonak |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1821418658 PECOS PAC ID: 4688890536 Enrollment ID: I20170728001552 |
| Provider Name | Casie L Coon |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1124688817 PECOS PAC ID: 2466883459 Enrollment ID: I20200506002600 |
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