Healthcare Provider Details

I. General information

NPI: 1124888151
Provider Name (Legal Business Name): JPS HEALTH NETWORK
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/19/2024
Last Update Date: 03/19/2024
Certification Date: 03/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 S MAIN ST
FORT WORTH TX
76104-4917
US

IV. Provider business mailing address

14361 CLOUDVIEW WAY
HASLET TX
76052-1414
US

V. Phone/Fax

Practice location:
  • Phone: 817-702-3000
  • Fax:
Mailing address:
  • Phone: 817-201-0323
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name: DR. JONAH GROOVER
Title or Position: PODIATRY RESIDENT
Credential: DPM
Phone: 817-201-0323