| Lake Worth Minor Emergency | |
|
6302 Jacksboro Hwy Ste A Fort Worth TX 76135-3607 | |
| (817) 237-8273 | |
| (817) 237-0374 |
| Full Name | Lake Worth Minor Emergency |
|---|---|
| Speciality | Family Medicine |
| Location | 6302 Jacksboro Hwy Ste A, Fort Worth, Texas |
| Authorized Official Name and Position | Glenda Wright (MANAGER) |
| Authorized Official Contact | 8172378273 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Lake Worth Minor Emergency 6302 Jacksboro Hwy Ste A Fort Worth TX 76135-3607 Ph: (817) 237-8273 | Lake Worth Minor Emergency 6302 Jacksboro Hwy Ste A Fort Worth TX 76135-3607 Ph: (817) 237-8273 |
| NPI Number | 1215217229 |
|---|---|
| Provider Enumeration Date | 08/22/2011 |
| Last Update Date | 10/17/2011 |
| Medicare PECOS PAC ID | 0547432262 |
|---|---|
| Medicare Enrollment ID | O20110930000285 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1215217229 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | F9351 (Texas) | Primary |
| Provider Name | Jerry T Davis |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1821179003 PECOS PAC ID: 9133391071 Enrollment ID: I20111116000702 |
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