MEDICARE: UNIVERSITY OF NORTH TEXAS HEALTH SCIENCE CENTER AT FORT WORTH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	363A00000X	Physician Assistant
2	367A00000X	Advanced Practice Midwife
3	363L00000X	Nurse Practitioner
4	207V00000X	Obstetrics & Gynecology 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	:	1659473056
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	UNIVERSITY OF NORTH TEXAS HEALTH SCIENCE CENTER AT FORT WORTH

Provider Business Mailing Address
First Line	:	PO BOX 99335
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76199-0335
Country	:	US
Telephone Number	:	817-735-2000
Fax Number	:

Provider Business Practice Location Address
First Line	:	1307 8TH AVE STE 403
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76104-4143
Country	:	US
Telephone Number	:	682-207-1375
Fax Number	:	682-207-1377

Authorized Official
Title or Position	:	REVENUE CYCLE DIRECTOR
Name	:	LESLIE HENDERSON
Credential	:
Telephone Number	:	817-735-2008

Provider Enumeration Date	:	09/05/2006
Last Update Date	:	12/16/2019

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