Healthcare Provider Details

I. General information

NPI: 1831645217
Provider Name (Legal Business Name): EXTRA CARE CONCERNS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/26/2016
Last Update Date: 08/26/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2529 E LANCASTER AVE SUITE A
FORT WORTH TX
76103-2253
US

IV. Provider business mailing address

2529 E LANCASTER AVE SUITE A
FORT WORTH TX
76103-2253
US

V. Phone/Fax

Practice location:
  • Phone: 817-534-7300
  • Fax:
Mailing address:
  • Phone: 817-534-7300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: PATRICIA ROBERTS HARRIS
Title or Position: OWNER AND DOCTOR
Credential:
Phone: 817-534-7300