MEDICARE: T & R CLINIC A PROFESSIONAL ASSOCIATION

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	207Q00000X	Family Medicine Physician	M1311	TX
2	207Q00000X	Family Medicine Physician

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	CP0037	OTHER	TX	RAILROAD MEDICARE

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	:	1578514535
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	T & R CLINIC A PROFESSIONAL ASSOCIATION

Provider Business Mailing Address
First Line	:	2919 MARKUM DRIVE
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76117-4004
Country	:	US
Telephone Number	:	817-831-0321
Fax Number	:	817-831-3211

Provider Business Practice Location Address
First Line	:	2919 MARKUM DRIVE
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76117-4004
Country	:	US
Telephone Number	:	817-831-0321
Fax Number	:	817-831-3211

Authorized Official
Title or Position	:	PRESIDENT/MEDICAL DOCTOR
Name	:	SUCHITA D. REDDY
Credential	:	M.D.
Telephone Number	:	817-831-0321

Provider Enumeration Date	:	05/15/2006
Last Update Date	:	09/24/2010

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Directions to “T & R CLINIC A PROFESSIONAL ASSOCIATION ” Practice Location

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