Provider Demographics
NPI:1629250386
Name:HENRY HART NANCE JR DO PA
Entity Type:Organization
Organization Name:HENRY HART NANCE JR DO PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:HENRY
Authorized Official - Middle Name:HART
Authorized Official - Last Name:NANCE
Authorized Official - Suffix:JR
Authorized Official - Credentials:DO
Authorized Official - Phone:817-645-2122
Mailing Address - Street 1:141 WESTMEADOW DR
Mailing Address - Street 2:
Mailing Address - City:CLEBURNE
Mailing Address - State:TX
Mailing Address - Zip Code:76033-4126
Mailing Address - Country:US
Mailing Address - Phone:817-645-2122
Mailing Address - Fax:817-645-2112
Practice Address - Street 1:141 WESTMEADOW DR
Practice Address - Street 2:
Practice Address - City:CLEBURNE
Practice Address - State:TX
Practice Address - Zip Code:76033-4126
Practice Address - Country:US
Practice Address - Phone:817-645-2122
Practice Address - Fax:817-645-2112
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-04
Last Update Date:2011-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG3038208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXA67437Medicare UPIN