Provider Demographics
NPI:1295157030
Name:BEATY BUSINESS SPENDTHRIFT TRUST
Entity type:Organization
Organization Name:BEATY BUSINESS SPENDTHRIFT TRUST
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CINDY
Authorized Official - Middle Name:
Authorized Official - Last Name:BEATY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-737-6464
Mailing Address - Street 1:1605 CLOVER LN
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76107-3902
Mailing Address - Country:US
Mailing Address - Phone:817-737-6464
Mailing Address - Fax:
Practice Address - Street 1:1605 CLOVER LN
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76107-3902
Practice Address - Country:US
Practice Address - Phone:817-737-6464
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-14
Last Update Date:2014-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service