BRANCH MEDICAL CLINIC FT WORTH (NPI# 1114986932) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1114986932 |
| Entity Type | Organization |
| Organization Name | BRANCH MEDICAL CLINIC FT WORTH |
| Practice Address |
1711 Doolittle Ave Naval Air Station/ Jrb TX 76127 |
| Mailing Address |
1711 Doolittle Ave Naval Air Station/ Jrb TX 76127-1133 |
| Practice Telephone | 3619616079 |
| Practice Fax Number | 3619612611 |
| Mailing Telephone | 3619616079 |
| Mailing Fax Number | 3619612611 |
| Enumeration Date | 2006-03-21 |
| Last Update Date | 2018-05-25 |
| Authorized Official Name | WILLIAM M CONDON (BUMED UBO) |
| Authorized Official Telephone | 2404013643 |
| Is Organization Subpart | Y |
| Parent Organization Name | NAVAL HEALTH CLINIC CORPUS CHRISTI |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QM1100X |
Clinic/Center Specialization: Military/U.S. Coast Guard Outpatient |
Ambulatory Health Care Facilities |
| Street Address |
1711 DOOLITTLE AVE |
| City | NAVAL AIR STATION/ JRB |
| State | TX |
| Zip Code | 76127 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1134129661 | Paul Davidson Reagan | Dentist | 1711 Doolittle Ave, Naval Air Station/ Jrb, TX 76127-1133 | 2005-07-27 |
| 1184600744 | Kathleen Mcgowan | Family Medicine | 1711 Doolittle Ave, Naval Air Station/ Jrb, TX 76127-1133 | 2005-12-15 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1942654462 | Damon A Cates | Physician Assistant | Fmc Carswell, J St Bldg 3000, Fort Worth, TX 76127 | 2016-04-21 |
| 1821332628 | Patricia Byrd | Psychologist | 3000 'j' Street, Fort Worth, TX 76127 | 2012-11-16 |
| 1992976435 | Carlos Estevez | Physical Therapist | J Street Building 3000, Naval Air Station, Fort Worth, TX 76127 | 2008-03-12 |
| 1346284064 | National Vision, Inc. | Eyewear Supplier (Equipment, not the service) | 1880 Mlty Pky, Ft. Worth, TX 76127 | 2006-06-15 |
| 1679516330 | Texas Exchange Eye Care, L.p. | Optometrist | 1880 Military Parkway, Building 1880, Fort Worth, TX 76127 | 2006-06-13 |
| 1073571428 | Alysa Michele Jackson | Social Worker | 3000 'j' Street, Federal Medical Center, Carswell, Fort Worth, TX 76127 | 2006-05-03 |
| 1659366219 | Jeanette Grullon-mejia | Family Medicine | J Street, Building 3000, Fort Worth, TX 76127 | 2005-09-20 |
| 1700126570 | Dr Buie & Associates PC | Optometrist | 1880 Military Parkway, Ft. Worth, TX 76127 | 2013-02-15 |
| 1194022566 | William Resto-rivera | Military Health Care Provider | J Street Bldg 3000, Federal Medical Center Carswell, Fort Worth, TX 76127-0066 | 2011-02-22 |
| 1275961328 | Fort Worth Health Rejuvenation | Nursing Facility/Intermediate Care Facility | 3253 Desert Storm Rd, Fort Worth, TX 76127-1029 | 2013-10-29 |
| Find all providers in zip 76127 | ||||
| Taxonomy Code | 261QM1100X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Military/U.S. Coast Guard Outpatient |
| The Defense Health Program or U.S. Coast Guard funded "fixed" facilities or distinct parts of a facility, providing outpatient medical and dental services, primarily for Uniformed Services beneficiaries. A "fixed" facility is a non-temporary, non-deployed facility. It includes mobile specialty units such as Magnetic Resonance Imaging (MRI) units that may furnish services at the "fixed" facility. It includes, as examples, the institutional portion of outpatient encounters (except Ambulatory Procedure Visits), supplies issued (e.g., glasses, ostomy supplies, crutches), and radiology and laboratory studies. Does not include items issued directly to a patient from an outpatient pharmacy or patient transport. |
| Notes: Source: TRICARE Management Activity Uniform Business Office User’s Guide [1/1/2005: title modified, definition added; 7/1/2006 title modified, definition modified] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1326527177 | William Beaumont Army Medical Center | Clinic/Center | 11291 Sgt E Churchill St, Fort Bliss, TX 79918-8001 | 2018-08-13 |
| 1124505359 | Carl R Darnall Army Medical Center | Clinic/Center | 5200 Bunny Trail, Killeen, TX 76549 | 2018-07-20 |
| 1568948933 | Carl R Darnall Army Medical Center | Clinic/Center | 415 31st and 761st Tank Battalion, Fort Hood, TX 76544 | 2018-07-18 |
| 1740766112 | Carl R Darnall Army Medical Center | Clinic/Center | Bldg 2255 52nd and 761st Tank Battalion, Fort Hood, TX 76544 | 2018-07-18 |
| 1396119681 | Brooke Army Medical Center | Clinic/Center | 2407 N New Braunfels, Bldg 147, Ft Sam Houston, TX 78234 | 2015-11-24 |
| 1932595204 | Carl R Darnall Army Medical Center | Clinic/Center | 9410 19th St, Fort Hood, TX 76544 | 2015-04-13 |
| 1154717650 | Carl R Darnall Army Medical Center | Clinic/Center | 31002 74th Street, Fort Hood, TX 76544 | 2015-04-10 |
| 1073909578 | Carl R Darnall Army Medical Center | Clinic/Center | 37016 77th Street, Fort Hood, TX 76544 | 2015-04-10 |
| 1972999472 | Carl R Darnall Army Medical Center | Clinic/Center | 24001 Battalion Ave, 58th and 62nd Streets, Fort Hood, TX 76544 | 2015-04-10 |
| 1619365285 | Brooke Army Medical Center | Clinic/Center | 10010 Rogers Run, Suite 100, San Antonio, TX 78251-4403 | 2015-01-05 |
| Find all providers with the same taxonomy | ||||
| City | NAVAL AIR STATION/ JRB |
| Zip Code | 76127 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.