Provider Demographics
NPI:1538285143
Name:NORTH HILLS FAMILY PRACTICE
Entity Type:Organization
Organization Name:NORTH HILLS FAMILY PRACTICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CONTRACT MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:JEANETTE
Authorized Official - Middle Name:L
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-284-1165
Mailing Address - Street 1:4351 BOOTH CALLOWAY RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76180-7378
Mailing Address - Country:US
Mailing Address - Phone:817-284-1165
Mailing Address - Fax:817-284-4990
Practice Address - Street 1:816 KELLER PKWY
Practice Address - Street 2:SUITE 102
Practice Address - City:KELLER
Practice Address - State:TX
Practice Address - Zip Code:76248-2479
Practice Address - Country:US
Practice Address - Phone:817-431-3800
Practice Address - Fax:817-431-5232
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00T83UMedicare ID - Type UnspecifiedMEDICARE GROUP NUMBER