MEDICARE: MHMR-TC

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	251S00000X	Community/Behavioral Health Agency	462622	TX

General Provider Information

NPI Number	:	1063748853
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MHMR-TC

Provider Business Mailing Address
First Line	:	1200 CIRCLE DRIVE STE 400B
Second Line	:	MHMRTC
City	:	FT WORTH
State	:	TX
Zip	:	76119
Country	:	US
Telephone Number	:	817-569-4750
Fax Number	:	817-569-4796

Provider Business Practice Location Address
First Line	:	1200 CIRCLE DRIVE STE 400B
Second Line	:
City	:	FT WORTH
State	:	TX
Zip	:	76119
Country	:	US
Telephone Number	:	817-569-4750
Fax Number	:	817-569-4796

Authorized Official
Title or Position	:	MEDICAL DIRECTOR
Name	:	DR. JOSEPH BURKETT
Credential	:	MD
Telephone Number	:	817-549-4430

Provider Enumeration Date	:	10/29/2009
Last Update Date	:	10/29/2009

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