Healthcare Provider Details

I. General information

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

II. Dates (important events)

Enumeration Date: 08/25/2010
Last Update Date: 10/28/2024
Certification Date: 10/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2909 MITCHELL BLVD
FORT WORTH TX
76105-4642
US

IV. Provider business mailing address

2332 BEVERLY HILLS DR
FORT WORTH TX
76114-1756
US

V. Phone/Fax

Practice location:
  • Phone: 817-625-4254
  • Fax: 817-740-8612
Mailing address:
  • Phone: 817-625-4254
  • Fax: 817-740-8612

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number516819
License Number StateTX

VIII. Authorized Official

Name: GERRIE WHITAKER
Title or Position: CEO
Credential:
Phone: 817-625-4254