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General NPI Number Information
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NPI Number | 1790527174
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Entity Type | Organization
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Legal Business Name | FORTIS MED INCORPORATED
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Dates
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Enumeration Date | 06/07/2024
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Last Update Date | 06/07/2024
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Provider Practice Location Address
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Address Line | 12417 BELLA VINO DR
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City | FORT WORTH
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State | TX
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Zip | 76126-4929
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Country | US
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Telephone | 817-239-1071
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Fax | 817-782-9468
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Provider Business Mailing Address
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Address Line | 12417 BELLA VINO DR
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City | FORT WORTH
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State | TX
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Zip | 76126-4929
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Country | US
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Telephone | 817-239-1071
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Fax | 817-782-9468
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. SAVITA KURUP
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Credential | MD
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Telephone | 817-239-1071
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207QG0300X
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Taxonomy Name | Geriatric Medicine (Family Medicine) Physician
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License Number |
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License Number State |
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