UNIVERSITY OF NORTH TEXAS HEALTH SCIENCE CENTER AT FORT WORTH


Address: 855 Montgomery St, Fort Worth, TX 76107
Phone: 8177352000

UNIVERSITY OF NORTH TEXAS HEALTH SCIENCE CENTER AT FORT WORTH (NPI# 1003133083) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).

Provider Overview

Nation Provider ID (NPI) 1003133083
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 2010-04-29
Last Update Date 2018-06-12
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

Taxonomy

Primary Taxonomy Code Classification License Number License State Taxonomy Group
N 363A00000X Physician Assistant Physician Assistants & Advanced Practice Nursing Providers
N 363L00000X Nurse Practitioner Physician Assistants & Advanced Practice Nursing Providers
Y 207Q00000X Family Medicine Allopathic & Osteopathic Physicians

Other Provider Identifier

State Issuer Identifier Type Code
TX BCBS 0056TW 01

Provider Secondary Practice Location

Address Telephone Number Fax Number
2737 Sherman St, Grand Prairie, TX 750511027 8177352000

Other Provider IDs and Locations

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
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
1417054024 University of North Texas Health Science Center At Fort Worth Allergy & Immunology 855 Montgomery St, Fort Worth, TX 76107 2006-09-19
1053416289 University of North Texas Health Science Center At Fort Worth Physician Assistant 855 Montgomery St, Fort Worth, TX 76107 2006-09-13

Other Data Sources

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

Office Location

Street Address 855 MONTGOMERY ST
City FORT WORTH
State TX
Zip Code 76107

Providers in the same location

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
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Providers in the same zip code

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
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Taxonomy Information

Taxonomy Code 207Q00000X
Grouping Allopathic & Osteopathic Physicians
Classification Family Medicine

Taxonomy Definition

Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity.
Notes: Source: American Board of Family Medicine [1/1/2007: changed title; 7/1/2007: added definition, added source; 7/1/2017: modified definition]
- Note: The American Osteopathic Board of Family Physicians certification includes extensive use of Osteopathic Manipulative Treatment (OMT), which integrates the biological, clinical, and behavioral sciences.
- Additional Resources: American Board of Family Medicine, www.theabfm.org. American Osteopathic Board of Family Physicians, www.osteopathic.org/certification
- Board certification for Medical Doctors (MDs) is provided by the American Board of Family Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Family Physicians or the American Board of Family Medicine.

Providers in the same taxonomy and city

NPI Name Taxonomy Address Enumeration
1770184020 Kara Fenceroy Family Medicine 5425 Rolling Meadows Dr, Fort Worth, TX 76123-2836 2020-11-03
1003416207 Adeline Galvez Family Medicine 1300 W Terrell Ave Ste 270, Fort Worth, TX 76104-2820 2020-10-27
1952870354 Nancy Carolina Nicoloso Family Medicine 6302 Lake Worth Blvd Ste A3963, Fort Worth, TX 76135-3607 2018-11-15
1245717586 Julia Dubose Family Medicine 4100 Heritage Trace Pkwy Ste 116, Fort Worth, TX 76244 2018-07-19
1609307115 Yara Hamade Gonzales Family Medicine 4701 Bryant Irvin Rd, Fort Worth, TX 76132-3603 2017-03-26
1558732321 Andres Morgado Perez Family Medicine 1325 Pennsylvania Ave Ste 750, Fort Worth, TX 76104-2168 2015-10-19
1114304805 Davis Wellness Ltd LLP Family Medicine 3750 S. University Dr., Suite 201, Fort Worth, TX 76109-3701 2015-05-01
1902298417 Jack Lynwood Judson, Md Family Medicine 1800 Malibar Rd, Fort Worth, TX 76116-1834 2015-02-21
1104243468 Henry Dollahite Family Medicine 6205 Locke Ave, Fort Worth, TX 76116-4636 2014-03-25
1447676689 Janet Shackelford Family Medicine 5001 Golden Triangle Blvd, # 1024, Fort Worth, TX 76244 2014-03-12
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Competitor

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City FORT WORTH
Zip Code 76107

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Dataset Information

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.

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