Provider Demographics
NPI:1306829437
Name:FC OF TEXAS INC
Entity Type:Organization
Organization Name:FC OF TEXAS INC
Other - Org Name:INTREPID USA HEALTHCARE SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:M
Authorized Official - Last Name:KUNYSZ
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:214-445-3750
Mailing Address - Street 1:3220 KELLER SPRINGS RD STE 108
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:TX
Mailing Address - Zip Code:75006-5911
Mailing Address - Country:US
Mailing Address - Phone:214-445-3750
Mailing Address - Fax:214-445-3900
Practice Address - Street 1:3220 KELLER SPRINGS RD STE 108
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:TX
Practice Address - Zip Code:75006-5911
Practice Address - Country:US
Practice Address - Phone:214-688-0330
Practice Address - Fax:214-630-6061
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-22
Last Update Date:2019-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX008790251E00000X
251J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No251J00000XAgenciesNursing Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX164891703Medicaid
TX164891703Medicaid