MEDICARE: DPC HEALTH PLLC

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	261QP2300X	Primary Care Clinic/Center

General Provider Information

NPI Number	:	1326661703
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DPC HEALTH PLLC

Provider Business Mailing Address
First Line	:	4561 HERITAGE TRACE PKWY STE 109
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76244-8907
Country	:	US
Telephone Number	:	682-200-0035
Fax Number	:	682-708-6150

Provider Business Practice Location Address
First Line	:	4561 HERITAGE TRACE PKWY STE 109
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76244-8907
Country	:	US
Telephone Number	:	682-200-0035
Fax Number	:	682-708-6150

Authorized Official
Title or Position	:	OWNER
Name	:	TRAM NGUYEN
Credential	:
Telephone Number	:	682-200-0035

Provider Enumeration Date	:	05/20/2020
Last Update Date	:	05/27/2020

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