MEDICARE: NORTH TEXAS AREA COMMUNITY HEALTH CENTERS, INC

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	207Q00000X	Family Medicine Physician		TX
2	261QF0400X	Federally Qualified Health Center (FQHC)	516819	TX

General Provider Information

NPI Number	:	1700192085
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTH TEXAS AREA COMMUNITY HEALTH CENTERS, INC

Provider Business Mailing Address
First Line	:	2332 BEVERLY HILLS DR
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76114-1756
Country	:	US
Telephone Number	:	817-625-4254
Fax Number	:	817-740-8612

Provider Business Practice Location Address
First Line	:	2909 MITCHELL BLVD
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76105-4642
Country	:	US
Telephone Number	:	817-625-4254
Fax Number	:	817-740-8612

Authorized Official
Title or Position	:	CEO
Name	:	GERRIE WHITAKER
Credential	:
Telephone Number	:	817-625-4254

Provider Enumeration Date	:	08/25/2010
Last Update Date	:	10/28/2024

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