Provider Demographics
NPI:1669686937
Name:FORT WORTH PERINATAL ASSOCIATES, P.A.
Entity Type:Organization
Organization Name:FORT WORTH PERINATAL ASSOCIATES, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:DANI
Authorized Official - Middle Name:
Authorized Official - Last Name:HURTADO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-332-6667
Mailing Address - Street 1:1250 8TH AVE
Mailing Address - Street 2:SUITE 570
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76104-4146
Mailing Address - Country:US
Mailing Address - Phone:817-332-6667
Mailing Address - Fax:817-546-0946
Practice Address - Street 1:1250 8TH AVE
Practice Address - Street 2:SUITE 570
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-4146
Practice Address - Country:US
Practice Address - Phone:817-332-6667
Practice Address - Fax:817-546-0946
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-09
Last Update Date:2010-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX159573801Medicaid
TX159572001Medicaid
TX131688707Medicaid
TX131688707Medicaid
TX00400VMedicare PIN
TX159573801Medicaid