MEDICARE: JENNIFER C HEATH MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0800X	Psychiatry Physician	J6998	TX

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	260035942	OTHER	TX	MEDICARE RAILROAD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	0098BW	OTHER	TX	BLUE CROSS BLUE SHIELD
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1326058934
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER C HEATH MD

Provider Business Mailing Address
First Line	:	PO BOX 2710
Second Line	:
City	:	COPPELL
State	:	TX
Zip	:	75019
Country	:	US
Telephone Number	:	972-258-9570
Fax Number	:	972-258-9569

Provider Business Practice Location Address
First Line	:	6410 SOUTHWEST BLVD #101
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76109
Country	:	US
Telephone Number	:	817-735-1888
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/08/2006
Last Update Date	:	07/07/2008

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