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General NPI Number Information
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NPI Number | 1780969881
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Entity Type | Organization
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Legal Business Name | FORT WORTH MEDTEX LP
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Dates
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Enumeration Date | 10/20/2011
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Last Update Date | 10/20/2011
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Provider Practice Location Address
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Address Line | 1307 8TH AVE SUITE 603
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City | FORT WORTH
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State | TX
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Zip | 76104-4137
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Country | US
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Telephone | 817-924-4700
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Fax | 817-924-4703
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Provider Business Mailing Address
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Address Line | 1034 S BRENTWOOD BLVD SUITE 1250
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City | SAINT LOUIS
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State | MO
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Zip | 63117-1223
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Country | US
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Telephone | 817-924-4700
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Fax | 817-924-4703
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Authorized Official
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Title or Position | QWNER
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Name | DR. JAMES GREENWALD
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Credential | MD, PHD
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Telephone | 314-367-0777
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QX0100X
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Taxonomy Name | Occupational Medicine Clinic/Center
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License Number |
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License Number State |
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