Provider Demographics
NPI: | 1033181078 |
---|---|
Name: | UNIVERSITY OF NORTH TEXAS HEALTH SCIENCE CENTER AT FORT WORTH |
Entity Type: | Organization |
Organization Name: | UNIVERSITY OF NORTH TEXAS HEALTH SCIENCE CENTER AT FORT WORTH |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | REVENUE CYCLE DIRECTOR |
Authorized Official - Prefix: | |
Authorized Official - First Name: | LESLIE |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | HENDERSON |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 817-735-2008 |
Mailing Address - Street 1: | PO BOX 99335 |
Mailing Address - Street 2: | |
Mailing Address - City: | FORT WORTH |
Mailing Address - State: | TX |
Mailing Address - Zip Code: | 76199-0335 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 817-735-2000 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 855 MONTGOMERY ST |
Practice Address - Street 2: | |
Practice Address - City: | FORT WORTH |
Practice Address - State: | TX |
Practice Address - Zip Code: | 76107 |
Practice Address - Country: | US |
Practice Address - Phone: | 817-735-2000 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | Yes |
Parent Organization LBN: | UNIVERSITY OF NORTH TEXAS HEALTH SCIENCE CENTER AT FORT WORTH |
Parent Organization TIN: | <UNAVAIL> |
Enumeration Date: | 2006-02-03 |
Last Update Date: | 2018-06-06 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 207R00000X | Allopathic & Osteopathic Physicians | Internal Medicine | Group - Multi-Specialty | |
No | 103T00000X | Behavioral Health & Social Service Providers | Psychologist | Group - Multi-Specialty | |
No | 204D00000X | Allopathic & Osteopathic Physicians | Neuromusculoskeletal Medicine & OMM | Group - Multi-Specialty | |
No | 207KA0200X | Allopathic & Osteopathic Physicians | Allergy & Immunology | Allergy | Group - Multi-Specialty |
No | 207Q00000X | Allopathic & Osteopathic Physicians | Family Medicine | Group - Multi-Specialty | |
No | 207V00000X | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Group - Multi-Specialty | |
No | 207X00000X | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Group - Multi-Specialty | |
No | 208000000X | Allopathic & Osteopathic Physicians | Pediatrics | Group - Multi-Specialty | |
No | 2083P0011X | Allopathic & Osteopathic Physicians | Preventive Medicine | Undersea and Hyperbaric Medicine | Group - Multi-Specialty |
No | 2084P0800X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry | Group - Multi-Specialty |
No | 208600000X | Allopathic & Osteopathic Physicians | Surgery | Group - Multi-Specialty | |
No | 213E00000X | Podiatric Medicine & Surgery Service Providers | Podiatrist | Group - Multi-Specialty | |
No | 363A00000X | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Group - Multi-Specialty | |
No | 363L00000X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Group - Multi-Specialty | |
No | 367A00000X | Physician Assistants & Advanced Practice Nursing Providers | Advanced Practice Midwife | Group - Multi-Specialty |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
TX | CQ2055 | Other | RAILROAD MEDICARE |