Healthcare Provider Details

I. General information

NPI: 1376581900
Provider Name (Legal Business Name): TEXAS MEDICINE RESOURCES, LLP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/04/2006
Last Update Date: 12/28/2020
Certification Date: 12/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6451 BRENTWOOD STAIR RD SUITE 200
FORT WORTH TX
76112-3200
US

IV. Provider business mailing address

PO BOX 8549
FORT WORTH TX
76124-0549
US

V. Phone/Fax

Practice location:
  • Phone: 817-496-9700
  • Fax:
Mailing address:
  • Phone: 817-451-4208
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: SARAH I PORTER
Title or Position: DIRECTOR OF PROVIDER ENROLLMENT
Credential:
Phone: 817-451-4208