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General NPI Number Information
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NPI Number | 1417054024
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Entity Type | Organization
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Legal Business Name | UNIVERSITY OF NORTH TEXAS HEALTH SCIENCE CENTER AT FORT WORTH
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Dates
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Enumeration Date | 09/19/2006
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Last Update Date | 06/06/2018
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Provider Practice Location Address
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Address Line | 855 MONTGOMERY ST
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City | FORT WORTH
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State | TX
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Zip | 76107
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Country | US
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Telephone | 817-735-2000
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 99335
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City | FORT WORTH
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State | TX
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Zip | 76199-0335
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Country | US
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Telephone | 817-735-2000
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Fax |
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Authorized Official
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Title or Position | REVENUE CYCLE DIRECTOR
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Name | LESLIE MCGEE HENDERSON
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Credential |
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Telephone | 817-735-2008
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207KA0200X
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Taxonomy Name | Allergy 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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number |
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License Number State |
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