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General NPI Number Information
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NPI Number | 1982969515
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Entity Type | Organization
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Legal Business Name | NORTH TEXAS PRIMARY CARE ASSOCIATES
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Dates
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Enumeration Date | 07/10/2012
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Last Update Date | 10/22/2015
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Provider Practice Location Address
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Address Line | 1701 RIVER RUN SUITE 210
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City | FORT WORTH
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State | TX
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Zip | 76107-6579
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Country | US
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Telephone | 817-332-8847
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Fax | 817-332-3614
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Provider Business Mailing Address
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Address Line | 1701 RIVER RUN SUITE 210
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City | FORT WORTH
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State | TX
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Zip | 76107-6579
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Country | US
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Telephone | 817-332-8847
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Fax | 817-332-3614
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Authorized Official
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Title or Position | DIRECTOR
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Name | DR. STUART C. PICKELL
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Credential | MD
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Telephone | 817-732-8847
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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