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NPI Code Detail

MEDICARE: HEALTHDRIVE MEDICAL SERVICES OF TEXAS LLC

MEDICARE: HEALTHDRIVE MEDICAL SERVICES OF TEXAS LLC
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
1363L00000XNurse Practitioner

General Provider Information

NPI Number : 1457132169
Entity Type Code : Organization
Provider Name (Legal Business Name) : HEALTHDRIVE MEDICAL SERVICES OF TEXAS LLC
Provider Business Mailing Address
First Line : 100 CROSSING BLVD STE 300
Second Line :
City : FRAMINGHAM
State : MA
Zip : 01702-5555
Country : US
Telephone Number : 617-964-6681
Fax Number : 339-686-2561
Provider Business Practice Location Address
First Line : 2413 E LOOP 820 N
Second Line :
City : FORT WORTH
State : TX
Zip : 76118-6933
Country : US
Telephone Number : 888-964-6681
Fax Number : 888-662-0859
Authorized Official
Title or Position : PRESIDENT
Name : DANIEL BAKER
Credential :
Telephone Number : 857-255-0486
Provider Enumeration Date : 10/09/2023
Last Update Date : 10/09/2023

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Directions to “HEALTHDRIVE MEDICAL SERVICES OF TEXAS LLC ” Practice Location

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