| Southeast Community Health Center | |
|
2909 Mitchell Blvd Fort Worth TX 76105-4642 | |
| (817) 625-4254 | |
| (817) 740-8612 |
| Full Name | Southeast Community Health Center |
|---|---|
| Speciality | Clinic/Center |
| Location | 2909 Mitchell Blvd, Fort Worth, Texas |
| Authorized Official Name and Position | Gerrie Whitaker (CEO) |
| Authorized Official Contact | 8176254254 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Southeast Community Health Center 2332 Beverly Hills Dr Fort Worth TX 76114-1756 Ph: (817) 625-4254 | Southeast Community Health Center 2909 Mitchell Blvd Fort Worth TX 76105-4642 Ph: (817) 625-4254 |
| NPI Number | 1700192085 |
|---|---|
| Provider Enumeration Date | 08/25/2010 |
| Last Update Date | 10/28/2024 |
| Medicare PECOS PAC ID | 9931124450 |
|---|---|
| Medicare Enrollment ID | O20100903000465 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1700192085 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (Texas) | Secondary |
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | 516819 (Texas) | Primary |
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