Provider Demographics
NPI:1750332441
Name:TEXAS CENTERS FOR INFECTIOUS DISEASE ASSOCIATES PA
Entity Type:Organization
Organization Name:TEXAS CENTERS FOR INFECTIOUS DISEASE ASSOCIATES PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:KAY
Authorized Official - Last Name:MCDONALD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:817-810-9810
Mailing Address - Street 1:1025 COLLEGE AVE
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76104-3013
Mailing Address - Country:US
Mailing Address - Phone:817-810-9810
Mailing Address - Fax:
Practice Address - Street 1:1025 COLLEGE AVE
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-3013
Practice Address - Country:US
Practice Address - Phone:817-810-9811
Practice Address - Fax:817-810-9815
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-15
Last Update Date:2024-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Multi-Specialty
No3336C0003XSuppliersPharmacyCommunity/Retail PharmacyGroup - Multi-Specialty
No3336H0001XSuppliersPharmacyHome Infusion Therapy PharmacyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX079871202Medicaid
CH8204OtherMEDICARE RR GROUP
TX00099KOtherBCBS GROUP
TX00099KMedicare PIN
TX079871202Medicaid