Provider Demographics
NPI:1275884165
Name:FEDERAL BUREAU OF PRISONS
Entity Type:Organization
Organization Name:FEDERAL BUREAU OF PRISONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SERGIO
Authorized Official - Middle Name:
Authorized Official - Last Name:MONCADA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:817-782-4001
Mailing Address - Street 1:J STREET, BLDG 3000
Mailing Address - Street 2:FMC CARSWELL
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76127-7066
Mailing Address - Country:US
Mailing Address - Phone:817-782-4001
Mailing Address - Fax:817-782-4674
Practice Address - Street 1:J STREET, BLDG 3000
Practice Address - Street 2:FMC CARSWELL
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76127-7066
Practice Address - Country:US
Practice Address - Phone:817-782-4001
Practice Address - Fax:817-782-4674
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-02
Last Update Date:2012-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ9175282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital