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General NPI Number Information
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NPI Number | 1124356878
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Entity Type | Organization
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Legal Business Name | TEXAS HEALTH CARE, P.L.L.C.
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Dates
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Enumeration Date | 11/18/2009
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Last Update Date | 10/04/2011
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Provider Practice Location Address
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Address Line | 2821 LACKLAND ROAD, SUITE 216
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City | FORT WORTH
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State | TX
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Zip | 76116-4193
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Country | US
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Telephone | 817-378-3640
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Fax | 817-740-8516
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Provider Business Mailing Address
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Address Line | P.O. BOX 961205
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City | FORT WORTH
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State | TX
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Zip | 76161-1205
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Country | US
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Telephone | 817-740-8400
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Fax | 817-378-3699
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Authorized Official
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Title or Position | C.E.O.
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Name | LARRY D. TATUM
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Credential | M.D.
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Telephone | 817-740-8400
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207RC0200X
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Taxonomy Name | Critical Care Medicine (Internal Medicine) Physician
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License Number |
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License Number State |
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