FORT WORTH PEDIATRICS, P.A. (NPI# 1972623031) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1972623031 |
| Entity Type | Organization |
| Organization Name | FORT WORTH PEDIATRICS, P.A. |
| Practice Address |
1108 S Henderson St Fort Worth TX 76104-4430 |
| Mailing Address |
5708 Edwards Ranch Road Fort Worth TX 76109 |
| Practice Telephone | 8173353255 |
| Practice Fax Number | 8173366780 |
| Mailing Telephone | 8173364040 |
| Mailing Fax Number | 8173366780 |
| Enumeration Date | 2007-03-30 |
| Last Update Date | 2011-06-14 |
| Authorized Official Name | DIANE RICHEY (ADMINISTRATOR) |
| Authorized Official Telephone | 8173364040 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2080A0000X |
Pediatrics Specialization: Adolescent Medicine |
TX | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| TX | AMERIGROUP | 10001409 | 01 |
| TX | MEDICAID EPSDT | 130900703 | 01 |
| TX | BCBS | 00L72L | 01 |
| TX | 130900702 | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1760502835 | Fort Worth Pediatrics, P.a. | Pediatrics | 6401 Harris Pkwy, Suite100, Fort Worth, TX 76132-6101 | 2007-03-30 |
| Street Address |
1108 S HENDERSON ST |
| City | FORT WORTH |
| State | TX |
| Zip Code | 76104-4430 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1295736254 | Robert Mitchell Readinger | Pediatrics | 1108 S Henderson St, Fort Worth, TX 76104-4430 | 2005-08-02 |
| 1841637030 | Rachel Gambulos Hamilton | Pediatrics | 1108 S Henderson St, Fort Worth, TX 76104-4430 | 2013-05-28 |
| 1710219795 | Fort Worth Pediatrics | Pediatrics | 1108 S Henderson St, Fort Worth, TX 76104-4430 | 2010-02-02 |
| 1902048341 | Monica Milind Pradhan | Pediatrics | 1108 S Henderson St, Fort Worth, TX 76104-4430 | 2009-03-31 |
| 1972745644 | Jennifer Gittleman | Emergency Medicine | 1108 S Henderson St, Fort Worth, TX 76104-4430 | 2009-03-27 |
| 1740377175 | Gary B Strong | Pediatrics | 1108 S Henderson St, Fort Worth, TX 76104-4430 | 2006-10-06 |
| 1902864887 | Mark S. Jones | Pediatrics | 1108 S Henderson St, Fort Worth, TX 76104-4430 | 2006-05-02 |
| 1871551754 | R.l.stinson Jones | Pediatrics | 1108 S Henderson St, Fort Worth, TX 76104-4430 | 2006-05-02 |
| 1427016476 | Ramiro D. Cavazos | Pediatrics | 1108 S Henderson St, Fort Worth, TX 76104-4430 | 2006-05-01 |
| 1881651230 | William B. Scroggie | Pediatrics | 1108 S Henderson St, Fort Worth, TX 76104-4430 | 2006-04-28 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1669082186 | Cvs Pharmacy, Inc. | Durable Medical Equipment & Medical Supplies | 1115 8th St, Fort Worth, TX 76104 | 2020-08-10 |
| 1992343693 | Iris Giove | Psychologist | John Peter Smith Hospital, 1500 S. Main St., Fort Worth, TX 76104 | 2019-12-13 |
| 1104480656 | Swarnalaxmi Umapathy | Student in an Organized Health Care Education/Training Program | 900 8th Avenue, Fort Worth, TX 76104 | 2019-04-30 |
| 1881189132 | Mega Surgical Assistants LLC | Specialist/Technologist, Other | 1301pennsylvania, Fort Worth, TX 76104 | 2018-06-28 |
| 1356848899 | Tricia Kelly | Nurse Practitioner | 1325 Pennsylvania Avenue Suite 560, Fort Worth, TX 76104 | 2018-04-11 |
| 1952820979 | Modern Vein Clinic | Internal Medicine | 757 8th Avenue, Suite A, Forth Worth, TX 76104 | 2017-09-11 |
| 1790207165 | Vanessa Abbood | Dietitian, Registered | 900 Eighth Ave, Fns Department, Fort Worth, TX 76104 | 2017-07-07 |
| 1922537562 | Nicole Marie Tod | Student in an Organized Health Care Education/Training Program | 1500 S Main Street, Fort Worth, TX 76104 | 2017-06-07 |
| 1770025934 | Micah Bonola | Chiropractor | 1300 W. Rosedale St, Ste. A, Fort Worth, TX 76104 | 2016-11-04 |
| 1518315894 | United Bioscience, LLC. | Clinical Medical Laboratory | 901 W. Leuda St., B, Fort Worth, TX 76104 | 2016-05-27 |
| Find all providers in zip 76104 | ||||
| Taxonomy Code | 2080A0000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Pediatrics |
| Specialization | Adolescent Medicine |
| A pediatrician who specializes in adolescent medicine is a multi-disciplinary healthcare specialist trained in the unique physical, psychological and social characteristics of adolescents, their healthcare problems and needs. |
| 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/certification - 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 |
|---|---|---|---|---|
| 1710219795 | Fort Worth Pediatrics | Pediatrics | 1108 S Henderson St, Fort Worth, TX 76104-4430 | 2010-02-02 |
| 1801128889 | Fort Worth Pediatrics | Pediatrics | 5708 Edwards Ranch Road, Fort Worth, TX 76109 | 2010-02-02 |
| 1629300603 | Fort Worth Pediatrics | Pediatrics | 6401 Harris Pkwy, Suite 100, Fort Worth, TX 76132-6101 | 2010-02-02 |
| 1760502835 | Fort Worth Pediatrics, P.a. | Pediatrics | 6401 Harris Pkwy, Suite100, Fort Worth, TX 76132-6101 | 2007-03-30 |
| 1407808652 | Fort Worth Pediatrics | Pediatrics | 5708 Edwards Ranch Road, Fort Worth, TX 76109 | 2006-05-16 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1619440450 | Wishing Well Children's Clinic, Pllc | Pediatrics | 1259 Fm 1463, Suite 300, Katy, TX 77494 | 2019-01-04 |
| 1447789250 | Ab Pediatric Health Clinic Pllc | Pediatrics | 1400 N El Paso St Ste E, El Paso, TX 79902-3438 | 2017-06-06 |
| 1205284619 | Asha Davidson | Pediatrics | 6431 Fannin St Ste Msb 3126, Houston, TX 77030-1501 | 2016-05-25 |
| 1295113538 | Chandra Garvey | Pediatrics | 3600 Shire Blvd Ste 110, Richardson, TX 75082-2236 | 2015-05-06 |
| 1588099360 | Jennifer L Pitts | Pediatrics | 23920 Katy Fwy Ste 150, Katy, TX 77494-0881 | 2013-09-11 |
| 1699018705 | Steven Anthony Ricondo | Pediatrics | 6701 Fannin St Ste 1710, Houston, TX 77030-2616 | 2013-03-27 |
| 1568708006 | Marvin Ray Raley | Pediatrics | 1221 Welch St Apt 2, Houston, TX 77006-1180 | 2013-01-02 |
| 1346575867 | Andre Youssef Zarzour | Pediatrics | 8615 Herts Rd, Spring, TX 77379-6720 | 2009-10-16 |
| 1386885499 | Rockwall Medical Association, Pa | Pediatrics | 114 Kenway St, Rockwall, TX 75087-3536 | 2009-03-19 |
| 1851576516 | Elgin Pediatrics, Pa | Pediatrics | 214 Highway 290 E, Elgin, TX 78621-3214 | 2007-12-31 |
| Find all providers with the same taxonomy | ||||
| City | FORT WORTH |
| Zip Code | 76104 |
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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.