MEDICARE: TEXACARE URGENT CARE, 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	207P00000X	Emergency Medicine Physician
2	261QU0200X	Urgent Care Clinic/Center

General Provider Information

NPI Number	:	1376090472
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TEXACARE URGENT CARE, PLLC

Provider Business Mailing Address
First Line	:	PO BOX 721561
Second Line	:
City	:	NORMAN
State	:	OK
Zip	:	73070-8201
Country	:	US
Telephone Number	:	877-485-4474
Fax Number	:	405-844-1794

Provider Business Practice Location Address
First Line	:	3107 GREENE AVE STE 1
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76109-2319
Country	:	US
Telephone Number	:	803-979-4903
Fax Number	:

Authorized Official
Title or Position	:	PARTNER/AUTHORIZED OFFICIAL
Name	:	SHANE PARKER COLE
Credential	:	MD
Telephone Number	:	877-485-4474

Provider Enumeration Date	:	09/06/2016
Last Update Date	:	02/17/2022

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