Provider Demographics
NPI:1407050057
Name:UROLOGY CONSULTANTS OF FORT WORTH LLP
Entity Type:Organization
Organization Name:UROLOGY CONSULTANTS OF FORT WORTH LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LIMITED PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SIDNEY
Authorized Official - Middle Name:A
Authorized Official - Last Name:WORSHAM
Authorized Official - Suffix:III
Authorized Official - Credentials:MD
Authorized Official - Phone:817-877-1288
Mailing Address - Street 1:800 8TH AVE
Mailing Address - Street 2:SUITE 626
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76104-2601
Mailing Address - Country:US
Mailing Address - Phone:817-877-1288
Mailing Address - Fax:817-877-5242
Practice Address - Street 1:800 8TH AVE
Practice Address - Street 2:SUITE 626
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-2601
Practice Address - Country:US
Practice Address - Phone:817-877-1288
Practice Address - Fax:817-877-5242
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-14
Last Update Date:2010-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXD8491208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0814303-01Medicaid
TX340016085Medicare PIN
TXCK6515Medicare PIN
TX0095AUMedicare PIN
TX340013172Medicare PIN