Healthcare Provider Details
I. General information
NPI: 1447619549
Provider Name (Legal Business Name): HURST TOTAL CARE PA
Entity Type: Organization
Gender:
Sole Proprietor:
II. Dates (important events)
Enumeration Date: 02/17/2016
Last Update Date: 02/17/2016
Certification Date:
Deactivation Date:
Reactivation Date:
III. Provider practice location address
400 MID CITIES BLVD
HURST TX
76054-2430
US
IV. Provider business mailing address
6049 S HULEN ST SUITE B
FORT WORTH TX
76132-4815
US
V. Phone/Fax
- Phone: 817-346-3313
- Fax: 817-346-3491
- Phone: 817-346-3313
- Fax: 817-346-3491
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 207Q00000X |
| Taxonomy | Family Medicine Physician |
| License Number | |
| License Number State | |
VIII. Authorized Official
Name: DR.
WALID
SAADE
Title or Position: PHYSICIAN OWNER
Credential: M.D.
Phone: 817-346-3313