MEDICARE: MONITOR PROFESSIONALS PA

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	174400000X	Specialist

General Provider Information

NPI Number	:	1386134310
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MONITOR PROFESSIONALS PA

Provider Business Mailing Address
First Line	:	7101 BRYANT IRVIN ROAD
Second Line	:	#34504
City	:	FT. WORTH
State	:	TX
Zip	:	76162-5009
Country	:	US
Telephone Number	:	817-406-8350
Fax Number	:

Provider Business Practice Location Address
First Line	:	7101 BRYANT IRVIN ROAD
Second Line	:	#34504
City	:	FT. WORTH
State	:	TX
Zip	:	76162-5009
Country	:	US
Telephone Number	:	817-406-8350
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MR. MARK WYLIE
Credential	:
Telephone Number	:	817-944-6222

Provider Enumeration Date	:	05/15/2018
Last Update Date	:	05/15/2018

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Directions to “MONITOR PROFESSIONALS PA ” Practice Location

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