MEDICARE: TEXAS HEALTH URGENT CARE

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	261QU0200X	Urgent Care Clinic/Center

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

General Provider Information

NPI Number	:	1356066617
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TEXAS HEALTH URGENT CARE

Provider Business Mailing Address
First Line	:	9250 AMBERTON PKWY
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75243-3224
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5937 DONNELLY AVE
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76107-5811
Country	:	US
Telephone Number	:	469-495-9142
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	NICHOLE JEANETTE CHAVEZ
Credential	:
Telephone Number	:	469-858-4343

Provider Enumeration Date	:	10/10/2022
Last Update Date	:	10/10/2022

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