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NPI Code Detail

MEDICARE: TEXAS HEALTH CARE PLLC

MEDICARE: TEXAS HEALTH 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
1207Y00000XOtolaryngology Physician

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1639441751
Entity Type Code : Organization
Provider Name (Legal Business Name) : TEXAS HEALTH CARE PLLC
Provider Business Mailing Address
First Line : PO BOX 961205
Second Line :
City : FORT WORTH
State : TX
Zip : 76161-1205
Country : US
Telephone Number : 817-740-8400
Fax Number : 817-378-3699
Provider Business Practice Location Address
First Line : 1250 8TH AVENUE, SUITE 205
Second Line :
City : FORT WORTH
State : TX
Zip : 76104-4158
Country : US
Telephone Number : 817-335-8151
Fax Number : 817-926-2531
Authorized Official
Title or Position : C.E.O.
Name : LARRY D. TATUM
Credential : M.D.
Telephone Number : 817-740-8400
Provider Enumeration Date : 02/06/2012
Last Update Date : 06/12/2012

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Directions to “TEXAS HEALTH CARE PLLC ” Practice Location

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