Healthcare Provider Details

I. General information

NPI: 1477260065
Provider Name (Legal Business Name): FPACP MIDLOTHIAN LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/02/2022
Last Update Date: 11/02/2022
Certification Date: 10/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 DYLAN WAY
MIDLOTHIAN TX
76065
US

IV. Provider business mailing address

1401 BALLINGER ST
FORT WORTH TX
76102-5905
US

V. Phone/Fax

Practice location:
  • Phone: 817-632-1000
  • Fax: 817-632-1001
Mailing address:
  • Phone: 801-632-1000
  • Fax: 817-632-1001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: MS. EVA M ZAMORA
Title or Position: PARALEGAL
Credential:
Phone: 806-379-0399