UNIVERSITY OF NORTH TEXAS HEALTH SCIENCE CENTER AT FORT WORTH (NPI# 1053416289) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1053416289 |
| 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 | 2006-09-13 |
| Last Update Date | 2018-05-29 |
| 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 | 363A00000X | Physician Assistant | Physician Assistants & Advanced Practice Nursing Providers | ||
| N | 363L00000X | Nurse Practitioner | Physician Assistants & Advanced Practice Nursing Providers | ||
| Y | 207R00000X | Internal Medicine | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MEDICARE | 00BA05 | 01 | |
| TX | 138980109 | 05 | |
| TX | RAILROAD MEDICARE | CQ2055 | 01 |
| 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 |
| 1417054024 | University of North Texas Health Science Center At Fort Worth | Allergy & Immunology | 855 Montgomery St, Fort Worth, TX 76107 | 2006-09-19 |
| 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 | 207R00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Internal Medicine |
| A physician who provides long-term, comprehensive care in the office and the hospital, managing both common and complex illness of adolescents, adults and the elderly. Internists are trained in the diagnosis and treatment of cancer, infections and diseases affecting the heart, blood, kidneys, joints and digestive, respiratory and vascular systems. They are also trained in the essentials of primary care internal medicine, which incorporates an understanding of disease prevention, wellness, substance abuse, mental health and effective treatment of common problems of the eyes, ears, skin, nervous system and reproductive organs. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source; 7/1/2011: modified source] - Additional Resources: American Board of Internal Medicine, 2007. http://www.abim.org/. American Osteopathic Board of Internal Medicine, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Internal Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Internal Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1023581006 | Leon S Tio Md Pa | Internal Medicine | 800 8th Ave Ste 336, Fort Worth, TX 76104-2614 | 2019-01-02 |
| 1174009385 | Universal Clinical Care LLC. | Internal Medicine | 2502 Via Nicola Apt 3424, Fort Worth, TX 76109-5587 | 2018-07-11 |
| 1417458068 | Fort Worth Primary Care, Pllc | Internal Medicine | 800 8th Ave Ste 626, Fort Worth, TX 76104-2605 | 2018-02-27 |
| 1750753976 | Momentum Health Partners Pllc | Internal Medicine | 4551 Boat Club Rd, Fort Worth, TX 76135-2004 | 2015-10-27 |
| 1013399286 | Aman Kanti Patel | Internal Medicine | 2502 Via Nicola, Apt # 3424, Fort Worth, TX 76109-6566 | 2015-06-24 |
| 1053705855 | Deidi Ann Bergestuen | Internal Medicine | 5450 Clearfork Main Street Suite 300, Fort Worth, TX 76109-7208 | 2015-03-19 |
| 1992198188 | Jack Ni | Internal Medicine | Baylor Scott & White All Saints Medical Center, 1400 8th Ave, Fort Worth, TX 76104-4192 | 2015-03-11 |
| 1184054066 | Dfw Premier Healthcare Pa | Internal Medicine | 4844 Sangers Ct, Fort Worth, TX 76244-9119 | 2013-11-14 |
| 1588094593 | T Off Men's Health | Internal Medicine | 601 Penn St, Fort Worth, TX 76102-2619 | 2013-11-13 |
| 1174957054 | Medhealth Center Inc | Internal Medicine | 112 Nw 24th St Ste 206, Fort Worth, TX 76164-8577 | 2013-08-27 |
| 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.