Provider Demographics
NPI:1033311857
Name:ROCKWOOD MEDICAL CLINIC, P.A.
Entity Type:Organization
Organization Name:ROCKWOOD MEDICAL CLINIC, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MICHELE
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:GARZA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-625-7733
Mailing Address - Street 1:PO BOX 4705
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76164-0705
Mailing Address - Country:US
Mailing Address - Phone:817-625-7733
Mailing Address - Fax:817-740-1602
Practice Address - Street 1:1217 GRAND AVE
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76106-9041
Practice Address - Country:US
Practice Address - Phone:817-625-7733
Practice Address - Fax:817-740-1602
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-04
Last Update Date:2010-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH0411207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8J1230OtherBCBS
TX8A9698Medicare PIN
TX8J1230OtherBCBS