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NPI Code Detail

MEDICARE: LINDSEY SLACK D.O.

MEDICARE: LINDSEY SLACK D.O.
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
1208000000XPediatrics PhysicianS4515TX
2208M00000XHospitalist PhysicianS4515TX

General Provider Information

NPI Number : 1083145197
Entity Type Code : Individual
Provider Name (Legal Business Name) : LINDSEY SLACK D.O.
Provider Business Mailing Address
First Line : 1400 8TH AVE
Second Line :
City : FORT WORTH
State : TX
Zip : 76104-4110
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1400 8TH AVE
Second Line :
City : FORT WORTH
State : TX
Zip : 76104-4110
Country : US
Telephone Number : 817-944-0589
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/22/2017
Last Update Date : 06/22/2026

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Directions to “ LINDSEY SLACK D.O.” Practice Location

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