MEDICARE: NASA HEALTHCARE SERVICES 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	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1982287942
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NASA HEALTHCARE SERVICES LLC

Provider Business Mailing Address
First Line	:	6609 MCCART AVE
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76133-5633
Country	:	US
Telephone Number	:	817-386-7670
Fax Number	:	682-428-7559

Provider Business Practice Location Address
First Line	:	6609 MCCART AVE
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76133-5633
Country	:	US
Telephone Number	:	817-386-7670
Fax Number	:	682-428-7559

Authorized Official
Title or Position	:	OWNER
Name	:	AGNES MONGINA AONDO
Credential	:
Telephone Number	:	817-386-7670

Provider Enumeration Date	:	04/28/2021
Last Update Date	:	06/05/2026

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