MEDICARE: FT WORTH NEUROLOGY CONSULTANTS PA

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	2084N0400X	Neurology Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	00560X	OTHER	TX	BCBS

General Provider Information

NPI Number	:	1447244975
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FT WORTH NEUROLOGY CONSULTANTS PA

Provider Business Mailing Address
First Line	:	1307 8TH AVE
Second Line	:	SUITE 301
City	:	FORT WORTH
State	:	TX
Zip	:	76104-4137
Country	:	US
Telephone Number	:	817-920-0900
Fax Number	:	817-920-0969

Provider Business Practice Location Address
First Line	:	1307 8TH AVE
Second Line	:	SUITE 301
City	:	FORT WORTH
State	:	TX
Zip	:	76104-4137
Country	:	US
Telephone Number	:	817-920-0900
Fax Number	:	817-920-0969

Authorized Official
Title or Position	:	OWNER
Name	:	SHIRLEY A MOLENICH
Credential	:	MD
Telephone Number	:	817-920-0900

Provider Enumeration Date	:	09/12/2005
Last Update Date	:	07/12/2013

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Directions to “FT WORTH NEUROLOGY CONSULTANTS PA ” Practice Location

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