Provider Demographics
NPI:1861471955
Name:FORT WORTH INSTITUTE FOR CARDIAC CARE
Entity Type:Organization
Organization Name:FORT WORTH INSTITUTE FOR CARDIAC CARE
Other - Org Name:CARDIAC CENTER AT HARRIS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:ALLISON
Authorized Official - Middle Name:
Authorized Official - Last Name:ELROD
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:817-252-5070
Mailing Address - Street 1:1300 W TERRELL AVE
Mailing Address - Street 2:SUITE 401
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76104-2800
Mailing Address - Country:US
Mailing Address - Phone:817-252-5070
Mailing Address - Fax:817-252-5072
Practice Address - Street 1:1300 W TERRELL AVE
Practice Address - Street 2:SUITE 401
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-2800
Practice Address - Country:US
Practice Address - Phone:817-252-5070
Practice Address - Fax:817-252-5072
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXFTCC01Medicare ID - Type UnspecifiedIDTF