MEDICARE: TEXAS MEDICINE RESOURCES, LLP

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	363A00000X	Physician Assistant
2	207P00000X	Emergency 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

General Provider Information

NPI Number	:	1376581900
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TEXAS MEDICINE RESOURCES, LLP

Provider Business Mailing Address
First Line	:	PO BOX 8549
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76124-0549
Country	:	US
Telephone Number	:	817-451-4208
Fax Number	:

Provider Business Practice Location Address
First Line	:	6451 BRENTWOOD STAIR RD
Second Line	:	SUITE 200
City	:	FORT WORTH
State	:	TX
Zip	:	76112-3200
Country	:	US
Telephone Number	:	817-496-9700
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR OF PROVIDER ENROLLMENT
Name	:	SARAH I PORTER
Credential	:
Telephone Number	:	817-451-4208

Provider Enumeration Date	:	06/04/2006
Last Update Date	:	12/28/2020

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