MEDICARE: THE WOMEN'S CENTER OF TARRANT COUNTY

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	251V00000X	Voluntary or Charitable Agency

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1114906633	OTHER	TX	MEDICARE

General Provider Information

NPI Number	:	1376097998
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE WOMEN'S CENTER OF TARRANT COUNTY

Provider Business Mailing Address
First Line	:	1723 HEMPHILL ST
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76110-1516
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1723 HEMPHILL ST
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76110-1516
Country	:	US
Telephone Number	:	817-927-4040
Fax Number	:

Authorized Official
Title or Position	:	VICE PRESIDENT & CFO
Name	:	CATHY PHELPS
Credential	:
Telephone Number	:	817-927-4016

Provider Enumeration Date	:	08/11/2016
Last Update Date	:	08/11/2016

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Directions to “THE WOMEN'S CENTER OF TARRANT COUNTY ” Practice Location

Language	Start Address	Practice Location

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