MEDICARE: COMPLEX HEALTHCARE SOLUTIONS, 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
1	363L00000X	Nurse Practitioner

General Provider Information

NPI Number	:	1700423233
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COMPLEX HEALTHCARE SOLUTIONS, LLC

Provider Business Mailing Address
First Line	:	6040 CAMP BOWIE BLVD STE 24
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76116-5602
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4201 INTERWAY PL
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76018-5668
Country	:	US
Telephone Number	:	817-735-1180
Fax Number	:

Authorized Official
Title or Position	:	VICE PRESIDENT
Name	:	SELENA NIX
Credential	:
Telephone Number	:	817-988-0042

Provider Enumeration Date	:	12/03/2019
Last Update Date	:	05/31/2022

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Directions to “COMPLEX HEALTHCARE SOLUTIONS, LLC ” Practice Location

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