MEDICARE: TEXAS HEALTH CARE, P.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	207R00000X	Internal Medicine Physician

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	45D0900927	OTHER	TX	CLIA

General Provider Information

NPI Number	:	1124185814
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TEXAS HEALTH CARE, P.L.L.C.

Provider Business Mailing Address
First Line	:	P.O. BOX 961205
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76161-1205
Country	:	US
Telephone Number	:	817-740-8400
Fax Number	:	817-378-3699

Provider Business Practice Location Address
First Line	:	1622 8TH AVENUE
Second Line	:	SUITE 110
City	:	FORT WORTH
State	:	TX
Zip	:	76104-4155
Country	:	US
Telephone Number	:	817-926-2561
Fax Number	:	817-921-3708

Authorized Official
Title or Position	:	C.E.O.
Name	:	LARRY D. TATUM
Credential	:	M.D.
Telephone Number	:	817-740-8400

Provider Enumeration Date	:	01/02/2007
Last Update Date	:	09/18/2009

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Directions to “TEXAS HEALTH CARE, P.L.L.C. ” Practice Location

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