| Texas Health Care, P.l.l.c. | |
|
1622 8th Avenue Suite 110 Fort Worth TX 76104-4155 | |
| (817) 926-2561 | |
| (817) 921-3708 |
| Full Name | Texas Health Care, P.l.l.c. |
|---|---|
| Speciality | Internal Medicine |
| Location | 1622 8th Avenue, Fort Worth, Texas |
| Authorized Official Name and Position | Larry D. Tatum (C.E.O.) |
| Authorized Official Contact | 8177408400 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Texas Health Care, P.l.l.c. P.o. Box 961205 Fort Worth TX 76161-1205 Ph: (817) 740-8400 | Texas Health Care, P.l.l.c. 1622 8th Avenue Suite 110 Fort Worth TX 76104-4155 Ph: (817) 926-2561 |
| NPI Number | 1124185814 |
|---|---|
| Provider Enumeration Date | 01/02/2007 |
| Last Update Date | 09/18/2009 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1124185814 | NPI | - | NPPES |
| 155109501 | Medicaid | TX | |
| 45D0900927 | Other | TX | CLIA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (* (Not Available)) | Primary |
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