UNIVERSITY OF NORTH TEXAS HEALTH SCIENCE CENTER AT FORT WORTH (NPI# 1417054024) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1417054024 |
| Entity Type | Organization |
| Organization Name | UNIVERSITY OF NORTH TEXAS HEALTH SCIENCE CENTER AT FORT WORTH |
| Practice Address |
855 Montgomery St Fort Worth TX 76107 |
| Mailing Address |
Po Box 99335 Fort Worth TX 76199-0335 |
| Practice Telephone | 8177352000 |
| Mailing Telephone | 8177352000 |
| Enumeration Date | 2006-09-19 |
| Last Update Date | 2018-06-06 |
| Authorized Official Name | LESLIE MCGEE HENDERSON (REVENUE CYCLE DIRECTOR) |
| Authorized Official Telephone | 8177352008 |
| Is Organization Subpart | Y |
| Parent Organization Name | UNIVERSITY OF NORTH TEXAS HEALTH SCIENCE CENTER AT FORT WORTH |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 207KA0200X |
Allergy & Immunology Specialization: Allergy |
Allopathic & Osteopathic Physicians | ||
| N | 363A00000X | Physician Assistant | Physician Assistants & Advanced Practice Nursing Providers | ||
| Y | 208000000X | Pediatrics | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| TX | 138980120 | 05 | |
| TX | 023088001 | 05 | |
| TX | MEDICAID CSHCN | 023088002 | 01 |
| TX | 138980107 | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1659473056 | University of North Texas Health Science Center At Fort Worth | Advanced Practice Midwife | 1307 8th Ave Ste 403, Fort Worth, TX 76104-4143 | 2006-09-05 |
| 1992355499 | University of North Texas Health Science Center At Fort Worth | Neuromusculoskeletal Medicine & OMM | 1800 W Chestnut St, Denton, TX 76201 | 2019-09-17 |
| 1003133083 | University of North Texas Health Science Center At Fort Worth | Physician Assistant | 855 Montgomery St, Fort Worth, TX 76107 | 2010-04-29 |
| 1538383328 | University of North Texas Health Science Center At Fort Worth | Physician Assistant | 855 Montgomery St, Fort Worth, TX 76107 | 2007-04-12 |
| 1659595445 | University of North Texas Health Science Center At Fort Worth | Physician Assistant | 855 Montgomery St, Fort Worth, TX 76107 | 2007-04-12 |
| 1316060882 | University of North Texas Health Science Center At Fort Worth | Physician Assistant | 1305 E Seminary Dr, Fort Worth, TX 76115 | 2007-04-09 |
| 1891818381 | University of North Texas Health Science Center At Fort Worth | Physician Assistant | 855 Montgomery St, Fort Worth, TX 76107 | 2007-04-09 |
| 1578686127 | University of North Texas Health Science Center At Fort Worth | Physician Assistant | 3500 Camp Bowie Blvd, Fort Worth, TX 76107 | 2007-04-09 |
| 1144328634 | University of North Texas Health Science Center At Fort Worth | Psychologist | 855 Montgomery St, Fort Worth, TX 76107 | 2006-09-20 |
| 1053416289 | University of North Texas Health Science Center At Fort Worth | Physician Assistant | 855 Montgomery St, Fort Worth, TX 76107 | 2006-09-13 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| System for Award Management (SAM) Entities | UNIVERSITY OF NORTH TEXAS HEALTH SCIENCE CENTER AT FORT WORTH | 3500 Camp Bowie Blvd, Fort Worth, TX 76107-2553 |
| Street Address |
855 MONTGOMERY ST |
| City | FORT WORTH |
| State | TX |
| Zip Code | 76107 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1831194455 | Patricia Lowrimore | Psychiatry & Neurology | 855 Montgomery St, Fort Worth, TX 76107-2553 | 2005-06-20 |
| 1194353417 | Jason L Thompson | Student in an Organized Health Care Education/Training Program | 855 Montgomery St, Fort Worth, TX 76107-2553 | 2020-03-31 |
| 1639701808 | Tyrane Roberts-lagrone | Pharmacist | 855 Montgomery St, Fort Worth, TX 76107-2553 | 2020-02-06 |
| 1144860917 | Melissa Edwards Petersen | Clinical Neuropsychologist | 855 Montgomery St, Fort Worth, TX 76107-2553 | 2020-01-09 |
| 1629553813 | Lisa Jane Killam-worrall | Pharmacist | 855 Montgomery St, Fort Worth, TX 76107-2553 | 2018-10-03 |
| 1598250607 | Sima Taj Mozdbar | Optometrist | 855 Montgomery St, Fort Worth, TX 76107-2553 | 2018-06-30 |
| 1588153993 | Kristen Reuter | Social Worker | 855 Montgomery St, Fort Worth, TX 76107-2553 | 2018-05-02 |
| 1114431624 | Emily J. Clark | Counselor | 855 Montgomery St, Fort Worth, TX 76107-2553 | 2017-11-20 |
| 1275073215 | Elizabeth Svyatoslavna Balyakina | Student in an Organized Health Care Education/Training Program | 855 Montgomery St, Fort Worth, TX 76107-2553 | 2017-02-23 |
| 1588103659 | Frederick Olen Barnum Iv | Family Medicine | 855 Montgomery St, Fort Worth, TX 76107-2553 | 2017-02-21 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1629683602 | Renovo Wound and Hyperbarics Pllc | Emergency Medicine | 5668 Edwards Ranch Road, Suite 101, Fort Worth, TX 76107 | 2020-09-15 |
| 1669085437 | Ryan Bourgeois | Nurse Practitioner | 2917 Crocket Street, Fort Worth, TX 76107 | 2020-08-31 |
| 1053920546 | Christa Marie Widjaja | Optometrist | 1700 Montgomery St, Fort Worth, TX 76107 | 2020-07-30 |
| 1093351355 | Raymond Iannone | Pharmacist | 850 Montgomery St, Suite #310, Fort Worth, TX 76107 | 2019-11-21 |
| 1053963744 | Cumulus Injury Resolution, Inc. | Chiropractor | 4936 Byers Avenue, Fort Worth, TX 76107 | 2019-07-12 |
| 1770135576 | Shadia Osakwe | Physician Assistant | 855 Montgomery Street, Pediatric Clinic, Fort Worth, TX 76107 | 2019-07-11 |
| 1568945442 | Sachin P Patel | Physical Therapist | 4825 Wellesley St, Fort Worth, TX 76107 | 2018-09-07 |
| 1023594025 | Ftw Pharmacy Services Inc | Durable Medical Equipment & Medical Supplies | 2912 W 6th St Ste 150, Fort Worth, TX 76107 | 2018-07-13 |
| 1669974325 | Helen Williamson Elliott | Counselor | 1751 River Run #217, Fort Worth, TX 76107 | 2018-03-08 |
| 1487156931 | Pelvic Neuromonitoring Pllc | Electrodiagnostic Medicine | 111 Boland St #211, Ft Worth, TX 76107 | 2018-03-01 |
| Find all providers in zip 76107 | ||||
| Taxonomy Code | 208000000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Pediatrics |
| A pediatrician is concerned with the physical, emotional and social health of children from birth to young adulthood. Care encompasses a broad spectrum of health services ranging from preventive healthcare to the diagnosis and treatment of acute and chronic diseases. A pediatrician deals with biological, social and environmental influences on the developing child, and with the impact of disease and dysfunction on development. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Pediatrics, 2007. http://www.abp.org/. American Osteopathic Board of Pediatrics, 2007. http://www.osteopathic.org/certificatio - Board certification for Medical Doctors (MDs) is provided by the American Board of Pediatrics. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Pediatrics. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1376165191 | Telemedicine Advantage Concierge Urgent Care | Pediatrics | 4200 South Fwy Ste 100, Fort Worth, TX 76115-1407 | 2020-05-14 |
| 1942776638 | Melissa S Wright | Pediatrics | 6115 Camp Bowie Blvd, Fort Worth, TX 76116-5512 | 2018-10-19 |
| 1366975336 | Pragadeeswari Dhanasekaran | Pediatrics | 5887 Chesapeake Pl, Fort Worth, TX 76132-2660 | 2017-04-06 |
| 1275898280 | Suvarna Kolluri | Pediatrics | 9509 N Beach St Ste 102, Fort Worth, TX 76244-6399 | 2012-07-06 |
| 1881999613 | Joyce Keck Rafati | Pediatrics | 1263 W Rosedale St, Fort Worth, TX 76104-2801 | 2011-01-26 |
| 1386886802 | Eriel Hayes | Pediatrics | 3200 Riverfront Dr Ste 103, Fort Worth, TX 76107-6560 | 2009-03-30 |
| 1194980011 | Cherryll Phoebe Taruc Libed | Pediatrics | 4701 Bryant Irvin Rd. N, Jps Viola Pitts/como, Fort Worth, TX 76107-4917 | 2008-07-21 |
| 1366605735 | Carolyn Margaret Lentzsch-parcells | Pediatrics | 4200 South Hulen Stree, Suite 450, Fort Worth, TX 76109 | 2008-07-07 |
| 1366627655 | Courtney M Carter | Pediatrics | 3201 Western Center Blvd, Suite 125, Fort Worth, TX 76137-7134 | 2008-01-04 |
| 1902017494 | Raheela Hafeez,m.d., P.a. | Pediatrics | 855 Montgomery Street, Fort Worth, TX 76107-2553 | 2007-05-25 |
| Find all providers in FORT WORTH | ||||
| City | FORT WORTH |
| Zip Code | 76107 |
Please comment or provide details below to improve the information on UNIVERSITY OF NORTH TEXAS HEALTH SCIENCE CENTER AT FORT WORTH.
| 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.