Provider Demographics
NPI:1184813800
Name:J STEVEN WELCH DO PA
Entity type:Organization
Organization Name:J STEVEN WELCH DO PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:J
Authorized Official - Middle Name:STEVEN
Authorized Official - Last Name:WELCH
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:817-594-4223
Mailing Address - Street 1:100 ROOSTER COGBURN CT
Mailing Address - Street 2:
Mailing Address - City:WEATHERFORD
Mailing Address - State:TX
Mailing Address - Zip Code:76088-7228
Mailing Address - Country:US
Mailing Address - Phone:817-594-4223
Mailing Address - Fax:817-594-8058
Practice Address - Street 1:100 ROOSTER COGBURN CT
Practice Address - Street 2:
Practice Address - City:WEATHERFORD
Practice Address - State:TX
Practice Address - Zip Code:76088-7228
Practice Address - Country:US
Practice Address - Phone:817-594-4223
Practice Address - Fax:817-594-8058
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-18
Last Update Date:2009-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX178447201Medicaid
TX00192VMedicare PIN
TXH34374Medicare UPIN