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1053315010

NPI Code Detail

MEDICARE: JON MICHAEL BADGWELL M.D.

MEDICARE: JON MICHAEL BADGWELL M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207L00000X	Anesthesiology Physician	D8139	TX

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
7	00N47F	OTHER	TX	MEDICARE GROUP

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	107880104	OTHER	TX	FIRSTCARE COMMERICAL
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	140442853	OTHER	TX	CSHCN GROUP
8	201000424	OTHER	NM	PRESBYTERIAN COMMERCIAL
9	B174	OTHER		TRIWEST
10	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
11	87249Z	OTHER	TX	HMO BLUE
12	129844011	OTHER	TX	CSHCN
13	1447220850	OTHER	TX	NPI GROUP
14	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
15	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
16	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
17	8F0118	OTHER	TX	BC/BS

General Provider Information

NPI Number	:	1053315010
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JON MICHAEL BADGWELL M.D.

Provider Business Mailing Address
First Line	:	PO BOX 162835
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76161-2835
Country	:	US
Telephone Number	:	817-334-0530
Fax Number	:	817-334-0235

Provider Business Practice Location Address
First Line	:	801 7TH AVE
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76104-2733
Country	:	US
Telephone Number	:	682-885-4054
Fax Number	:	682-885-7497

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/08/2005
Last Update Date	:	05/26/2010

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Directions to “ JON MICHAEL BADGWELL M.D.” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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