Healthcare Provider Details

I. General information

NPI: 1629789524
Provider Name (Legal Business Name): HURST MEDICAL CLINIC CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/12/2022
Last Update Date: 04/27/2024
Certification Date: 04/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

330 GRAPEVINE HWY
HURST TX
76054-2429
US

IV. Provider business mailing address

2224 ROBERTS CUTOFF RD
FORT WORTH TX
76114-1889
US

V. Phone/Fax

Practice location:
  • Phone: 469-909-8692
  • Fax:
Mailing address:
  • Phone: 469-909-8692
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: MS. SADY RODRIGUEZ
Title or Position: PRESIDENT
Credential:
Phone: 469-909-8692