Provider Demographics
NPI:1578181889
Name:EMER NORTH FORT WORTH BEACH PHYSICIANS, PLLC
Entity Type:Organization
Organization Name:EMER NORTH FORT WORTH BEACH PHYSICIANS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:NEWSOM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:469-830-8200
Mailing Address - Street 1:2300 MATLOCK RD STE 35
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:TX
Mailing Address - Zip Code:76063-5018
Mailing Address - Country:US
Mailing Address - Phone:469-830-8200
Mailing Address - Fax:469-830-8201
Practice Address - Street 1:4551 WESTERN CENTER BLVD
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76137-2628
Practice Address - Country:US
Practice Address - Phone:817-428-4055
Practice Address - Fax:817-428-4054
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-13
Last Update Date:2023-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Single Specialty