MEDICARE: METROPLEX MEDICAL CENTRE - FORT WORTH

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	207Q00000X	Family Medicine Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1043627870	OTHER		GROUP NPI NUMBER

General Provider Information

NPI Number	:	1326505637
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	METROPLEX MEDICAL CENTRE - FORT WORTH

Provider Business Mailing Address
First Line	:	700 N PEARL ST STE N510
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75201-2863
Country	:	US
Telephone Number	:	214-580-7277
Fax Number	:

Provider Business Practice Location Address
First Line	:	201 COMMERCE ST
Second Line	:
City	:	FT WORTH
State	:	TX
Zip	:	76102-7206
Country	:	US
Telephone Number	:	214-580-7277
Fax Number	:

Authorized Official
Title or Position	:	PRACTICE MANAGER
Name	:	SNEHA PATEL
Credential	:
Telephone Number	:	214-580-7277

Provider Enumeration Date	:	02/22/2019
Last Update Date	:	06/11/2019

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