Healthcare Provider Details

I. General information

NPI: 1144948688
Provider Name (Legal Business Name): HOT SHOT MEDICAL GROUP, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/19/2022
Last Update Date: 01/14/2025
Certification Date: 01/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 OAKRIDGE LN
FORT WORTH TX
76134-1048
US

IV. Provider business mailing address

PO BOX 60390
FORT WORTH TX
76115-6390
US

V. Phone/Fax

Practice location:
  • Phone: 682-283-8704
  • Fax: 817-294-9677
Mailing address:
  • Phone: 682-283-8704
  • Fax: 682-418-4968

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code405300000X
TaxonomyPrevention Professional
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code363LC1500X
TaxonomyCommunity Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: VERA STRIDER
Title or Position: OWNER/ CEO
Credential:
Phone: 682-283-8704