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NPI Code Detail

MEDICARE: HOLLY CHU PA-C

MEDICARE: HOLLY CHU PA-C
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
1363AS0400XSurgical Physician AssistantPA11112TX

General Provider Information

NPI Number : 1841736626
Entity Type Code : Individual
Provider Name (Legal Business Name) : HOLLY CHU PA-C
Provider Business Mailing Address
First Line : 6301 HARRIS PKWY STE 300
Second Line :
City : FORT WORTH
State : TX
Zip : 76132-4266
Country : US
Telephone Number : 817-877-3432
Fax Number : 817-346-4394
Provider Business Practice Location Address
First Line : 6301 HARRIS PKWY STE 300
Second Line :
City : FORT WORTH
State : TX
Zip : 76132-4266
Country : US
Telephone Number : 817-877-3432
Fax Number : 817-346-4394
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/17/2017
Last Update Date : 04/21/2017

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Directions to “ HOLLY CHU PA-C” Practice Location

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