| Highway 30 Family Medical Center, Pa | |
|
1200 Woodhaven Blvd Fort Worth TX 76112-2376 | |
| (817) 429-8300 | |
| (817) 429-6167 |
| Full Name | Highway 30 Family Medical Center, Pa |
|---|---|
| Speciality | Family Medicine |
| Location | 1200 Woodhaven Blvd, Fort Worth, Texas |
| Authorized Official Name and Position | Michael D Hoffman (OWNER/PHYSICIAN) |
| Authorized Official Contact | 81742983000 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Highway 30 Family Medical Center, Pa 9991 Marsh Ln Dallas TX 75220-1766 Ph: (214) 358-0090 | Highway 30 Family Medical Center, Pa 1200 Woodhaven Blvd Fort Worth TX 76112-2376 Ph: (817) 429-8300 |
| NPI Number | 1174581912 |
|---|---|
| Provider Enumeration Date | 05/02/2006 |
| Last Update Date | 04/09/2012 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1174581912 | NPI | - | NPPES |
| 153458801 | Medicaid | TX | |
| 153458802 | Medicaid | TX |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
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