MEDICARE: TEXAS HEALTH CARE, P.L.L.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
1	207V00000X	Obstetrics & Gynecology Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	45D0971316	OTHER	TX	CLIA
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1912063371
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TEXAS HEALTH CARE, P.L.L.C.

Provider Business Mailing Address
First Line	:	P.O. 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	:	4760 BARWICK DRIVE,
Second Line	:	SUITE C
City	:	FORT WORTH
State	:	TX
Zip	:	76132-1529
Country	:	US
Telephone Number	:	817-346-9533
Fax Number	:	817-346-9788

Authorized Official
Title or Position	:	C.E.O.
Name	:	LARRY D. TATUM
Credential	:	M.D.
Telephone Number	:	817-740-8400

Provider Enumeration Date	:	12/29/2006
Last Update Date	:	09/30/2011

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