MEDICARE: CHIRONET, L.L.C.

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	208D00000X	General Practice Physician

General Provider Information

NPI Number	:	1083799209
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHIRONET, L.L.C.

Provider Business Mailing Address
First Line	:	3149 LACKLAND RD
Second Line	:	#104
City	:	FORT WORTH
State	:	TX
Zip	:	76116-4109
Country	:	US
Telephone Number	:	817-886-8890
Fax Number	:	817-886-8891

Provider Business Practice Location Address
First Line	:	3149 LACKLAND RD
Second Line	:	#104
City	:	FORT WORTH
State	:	TX
Zip	:	76116-4109
Country	:	US
Telephone Number	:	817-886-8890
Fax Number	:	817-886-8891

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. VAN A. HARTNITT
Credential	:
Telephone Number	:	817-886-8890

Provider Enumeration Date	:	10/26/2006
Last Update Date	:	05/25/2016

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Directions to “CHIRONET, L.L.C. ” Practice Location

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