Healthcare Provider Details

I. General information

NPI: 1265770507
Provider Name (Legal Business Name): FW NMC, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/22/2013
Last Update Date: 01/22/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 W 7TH ST
FORT WORTH TX
76102-2625
US

IV. Provider business mailing address

PO BOX 101572
FORT WORTH TX
76185-1572
US

V. Phone/Fax

Practice location:
  • Phone: 817-485-5100
  • Fax: 817-485-5101
Mailing address:
  • Phone: 817-485-5100
  • Fax: 817-485-5101

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZS0410X
TaxonomySurgical Technologist
License Number
License Number State

VIII. Authorized Official

Name: NICOLE LOWE
Title or Position: BILLING
Credential:
Phone: 817-485-5100