Provider Demographics
NPI:1740508076
Name:TARRANT COUNTY PUBLIC HEALTH
Entity type:Organization
Organization Name:TARRANT COUNTY PUBLIC HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:FAIN
Authorized Official - Last Name:NEVOIT
Authorized Official - Suffix:
Authorized Official - Credentials:ACRN
Authorized Official - Phone:817-321-4813
Mailing Address - Street 1:1101 S MAIN ST RM 1500
Mailing Address - Street 2:PREVENTIVE MEDICINE CLINIC
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76104-4802
Mailing Address - Country:US
Mailing Address - Phone:817-321-4813
Mailing Address - Fax:817-321-4809
Practice Address - Street 1:1101 S MAIN ST RM 1500
Practice Address - Street 2:PREVENTIVE MEDICINE CLINIC
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-4802
Practice Address - Country:US
Practice Address - Phone:817-321-4813
Practice Address - Fax:817-321-4809
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TARRANT COUNTY PUBLIC HEALTH
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-05-11
Last Update Date:2010-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX105716261QP0905X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP0905XAmbulatory Health Care FacilitiesClinic/CenterPublic Health, State or Local