Provider Demographics
NPI:1326207838
Name:BARTOSH, NICOLE SCHROCK (DO)
Entity Type:Individual
Prefix:DR
First Name:NICOLE
Middle Name:SCHROCK
Last Name:BARTOSH
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 WEST MAGNOLIA AVE
Mailing Address - Street 2:THE CENTER FOR CANCER AND BLOOD DISORDERS
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76104
Mailing Address - Country:US
Mailing Address - Phone:817-759-7000
Mailing Address - Fax:
Practice Address - Street 1:223 S MORGAN ST
Practice Address - Street 2:
Practice Address - City:GRANBURY
Practice Address - State:TX
Practice Address - Zip Code:76048-1953
Practice Address - Country:US
Practice Address - Phone:817-759-7000
Practice Address - Fax:817-759-7027
Is Sole Proprietor?:No
Enumeration Date:2008-06-09
Last Update Date:2023-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN7776207RH0003X, 207RX0202X, 207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX3207805-01Medicaid
TX3207805-02Medicaid
TX288630YR7DMedicare PIN
TX288630YR7EMedicare PIN