Provider Demographics
NPI:1467408427
Name:BARBARA BIRDWELL MD PA
Entity Type:Organization
Organization Name:BARBARA BIRDWELL MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:A
Authorized Official - Last Name:BIRDWELL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:817-370-0400
Mailing Address - Street 1:7100 OAKMONT BLVD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76132-3909
Mailing Address - Country:US
Mailing Address - Phone:817-370-0400
Mailing Address - Fax:817-370-0448
Practice Address - Street 1:7100 OAKMONT BLVD
Practice Address - Street 2:SUITE 101
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76132-3909
Practice Address - Country:US
Practice Address - Phone:817-370-0400
Practice Address - Fax:817-370-0448
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-25
Last Update Date:2014-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG8787207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0058CZOtherBC/BS GROUP NUMBER
TX080463501Medicaid
TX0058CZOtherBC/BS GROUP NUMBER