Provider Demographics
NPI:1376595348
Name:FORT WORTH HEALTHCARE SYSTEMS LLC
Entity Type:Organization
Organization Name:FORT WORTH HEALTHCARE SYSTEMS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINSTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:L
Authorized Official - Last Name:RILEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-943-9431
Mailing Address - Street 1:PO BOX 3770
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75208-1070
Mailing Address - Country:US
Mailing Address - Phone:817-377-4011
Mailing Address - Fax:817-377-9269
Practice Address - Street 1:1002 MONTGOMERY ST
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76107-2693
Practice Address - Country:US
Practice Address - Phone:817-377-4011
Practice Address - Fax:817-377-9269
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-17
Last Update Date:2011-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0041MAOtherBCBS
TX0041MAOtherBCBS