Provider Demographics
NPI:1467781138
Name:FOREST HILL MEDICAL CLINIC PA INC
Entity Type:Organization
Organization Name:FOREST HILL MEDICAL CLINIC PA INC
Other - Org Name:FOREST HILL MEDICAL CLINIC PA
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:IFEOMA
Authorized Official - Last Name:MENES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:817-563-6985
Mailing Address - Street 1:6619 FOREST HILL DRIVE
Mailing Address - Street 2:30
Mailing Address - City:FOREST HILL
Mailing Address - State:TX
Mailing Address - Zip Code:76140-1260
Mailing Address - Country:US
Mailing Address - Phone:817-563-6985
Mailing Address - Fax:817-563-4064
Practice Address - Street 1:6619 FOREST HILL DR
Practice Address - Street 2:SUITE 30
Practice Address - City:FOREST HILL
Practice Address - State:TX
Practice Address - Zip Code:76140-1260
Practice Address - Country:US
Practice Address - Phone:817-563-6985
Practice Address - Fax:817-563-4064
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-09
Last Update Date:2020-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN1764261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care