Provider Demographics
NPI: | 1821026352 |
---|---|
Name: | TEXAS HEALTH CARE, P.L.L.C. |
Entity Type: | Organization |
Organization Name: | TEXAS HEALTH CARE, P.L.L.C. |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | C.E.O. |
Authorized Official - Prefix: | |
Authorized Official - First Name: | LARRY |
Authorized Official - Middle Name: | D |
Authorized Official - Last Name: | TATUM |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | MD |
Authorized Official - Phone: | 817-740-8400 |
Mailing Address - Street 1: | P.O. BOX 961205 |
Mailing Address - Street 2: | |
Mailing Address - City: | FORT WORTH |
Mailing Address - State: | TX |
Mailing Address - Zip Code: | 76161-1205 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 817-740-8400 |
Mailing Address - Fax: | 817-378-3699 |
Practice Address - Street 1: | 6000 WESTERN PL STE 900 |
Practice Address - Street 2: | |
Practice Address - City: | FORT WORTH |
Practice Address - State: | TX |
Practice Address - Zip Code: | 76107-4691 |
Practice Address - Country: | US |
Practice Address - Phone: | 817-740-8400 |
Practice Address - Fax: | 817-378-3699 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2006-06-30 |
Last Update Date: | 2022-11-02 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 207Q00000X | Allopathic & Osteopathic Physicians | Family Medicine | Group - Multi-Specialty | |
No | 207R00000X | Allopathic & Osteopathic Physicians | Internal Medicine | Group - Multi-Specialty | |
No | 207RC0000X | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease | Group - Multi-Specialty |
No | 207V00000X | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Group - Multi-Specialty | |
No | 207W00000X | Allopathic & Osteopathic Physicians | Ophthalmology | Group - Multi-Specialty | |
No | 207X00000X | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Group - Multi-Specialty | |
No | 207Y00000X | Allopathic & Osteopathic Physicians | Otolaryngology | Group - Multi-Specialty | |
No | 208600000X | Allopathic & Osteopathic Physicians | Surgery | Group - Multi-Specialty | |
No | 2086S0122X | Allopathic & Osteopathic Physicians | Surgery | Plastic and Reconstructive Surgery | Group - Multi-Specialty |
No | 2086S0129X | Allopathic & Osteopathic Physicians | Surgery | Vascular Surgery | Group - Multi-Specialty |
No | 208C00000X | Allopathic & Osteopathic Physicians | Colon & Rectal Surgery | Group - Multi-Specialty | |
No | 208G00000X | Allopathic & Osteopathic Physicians | Thoracic Surgery (Cardiothoracic Vascular Surgery) | Group - Multi-Specialty | |
No | 208VP0014X | Allopathic & Osteopathic Physicians | Pain Medicine | Interventional Pain Medicine | Group - Multi-Specialty |
No | 225100000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Group - Multi-Specialty | |
No | 367A00000X | Physician Assistants & Advanced Practice Nursing Providers | Advanced Practice Midwife | Group - Multi-Specialty |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
TX | 155109501 | Medicaid | |
TX | 155109506 | Medicaid | |
CK8411 | Other | RAILROAD MEDICARE TARRANT COUNTY | |
TX | 155109506 | Medicaid |