MEDICARE: TEXAS CENTERS FOR INFECTIOUS DISEASE ASSOCIATES PA

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	3336C0003X	Community/Retail Pharmacy
2	3336H0001X	Home Infusion Therapy Pharmacy
3	207RI0200X	Infectious Disease Physician

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	CH8204	OTHER		MEDICARE RR GROUP

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
3	00099K	OTHER	TX	BCBS GROUP

General Provider Information

NPI Number	:	1750332441
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TEXAS CENTERS FOR INFECTIOUS DISEASE ASSOCIATES PA

Provider Business Mailing Address
First Line	:	1025 COLLEGE AVE
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76104-3013
Country	:	US
Telephone Number	:	817-810-9810
Fax Number	:

Provider Business Practice Location Address
First Line	:	1025 COLLEGE AVE
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76104-3013
Country	:	US
Telephone Number	:	817-810-9811
Fax Number	:	817-810-9815

Authorized Official
Title or Position	:	PROVIDER
Name	:	CHERYL KAY MCDONALD
Credential	:	MD
Telephone Number	:	817-810-9810

Provider Enumeration Date	:	05/15/2006
Last Update Date	:	01/04/2024

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Directions to “TEXAS CENTERS FOR INFECTIOUS DISEASE ASSOCIATES PA ” Practice Location

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