MEDICARE: MOMENTUM HEALTH PARTNERS 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
1	207R00000X	Internal Medicine Physician

General Provider Information

NPI Number	:	1750753976
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MOMENTUM HEALTH PARTNERS PLLC

Provider Business Mailing Address
First Line	:	100 ALEDO GROVE CT
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76126-6049
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4551 BOAT CLUB RD
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76135-2004
Country	:	US
Telephone Number	:	817-905-4017
Fax Number	:	888-507-6727

Authorized Official
Title or Position	:	OWNER
Name	:	SUSAN CONROY
Credential	:	DO
Telephone Number	:	817-320-9956

Provider Enumeration Date	:	10/27/2015
Last Update Date	:	10/27/2015

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