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General NPI Number Information
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NPI Number | 1538285143
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Entity Type | Organization
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Legal Business Name | NORTH HILLS FAMILY PRACTICE
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Dates
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Enumeration Date | 03/22/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 816 KELLER PKWY SUITE 102
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City | KELLER
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State | TX
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Zip | 76248-2479
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Country | US
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Telephone | 817-431-3800
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Fax | 817-431-5232
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Provider Business Mailing Address
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Address Line | 4351 BOOTH CALLOWAY RD SUITE 101
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City | FORT WORTH
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State | TX
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Zip | 76180-7378
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Country | US
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Telephone | 817-284-1165
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Fax | 817-284-4990
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Authorized Official
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Title or Position | CONTRACT MANAGER
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Name | MR. JEANETTE L MARTIN
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Credential |
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Telephone | 817-284-1165
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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