Healthcare Provider Details

I. General information

NPI: 1184036428
Provider Name (Legal Business Name): FT WORTH RANCH ASSIST, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/21/2014
Last Update Date: 11/21/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3516 RANCH VIEW TERRACE
FORT WORTH TX
76109
US

IV. Provider business mailing address

PO BOX 205715
DALLAS TX
75320-5715
US

V. Phone/Fax

Practice location:
  • Phone: 817-908-8124
  • Fax: 817-885-7339
Mailing address:
  • Phone: 817-908-8124
  • Fax: 817-885-7339

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License NumberM3737
License Number StateTX

VIII. Authorized Official

Name: CHARLES C NEFF
Title or Position: DIRECTOR
Credential:
Phone: 817-485-5100