Provider Demographics
NPI:1386814374
Name:FORT WORTH WOMAN'S CLINIC
Entity Type:Organization
Organization Name:FORT WORTH WOMAN'S CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:C
Authorized Official - Last Name:KOLAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:817-346-5252
Mailing Address - Street 1:6100 HARRIS PKWY STE 200
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76132-4131
Mailing Address - Country:US
Mailing Address - Phone:817-324-5252
Mailing Address - Fax:817-370-2288
Practice Address - Street 1:6100 HARRIS PKWY STE 200
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76132-4131
Practice Address - Country:US
Practice Address - Phone:817-324-5252
Practice Address - Fax:817-370-2288
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-05
Last Update Date:2008-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXF91007Medicare UPIN
TXE79699Medicare UPIN