NPIMap

Organization Active NPI

University of North Texas Health Science Center of Fort Worth

  • Clinical Pathology/Laboratory Medicine Physician
  • Fort Worth, TX
National Provider Identifier
1003001173
Registry record updated Jun 6, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Pathology/Laboratory Medicine PhysicianTaxonomy code 207ZP0105X
Legal business name
UNIVERSITY OF NORTH TEXAS HEALTH SCIENCE CENTER OF FORT WORTH
Practice address
855 Montgomery St
Fort Worth, TX 76107
Phone
(817) 735-2000
NPI assigned
Sep 11, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 6, 2018

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Leslie Henderson
Title
Revenue Cycle Director
Phone
(817) 735-2008

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Pathology/Laboratory Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207ZP0105X Primary

Addresses

Primary practice location

855 Montgomery St
Fort Worth, TX 76107

Mailing address

3500 Camp Bowie Blvd
Fort Worth, TX 76107-2644
Phone (817) 735-2000

Other identifiers 1

IdentifierTypeStateIssuer
138980112MedicaidTX

National Provider Directory

National Provider Directory
Tax ID family
Texas College of Osteop11 organizations share this tax ID, including this one

Other organizations with this tax ID 10

Organizations that report the same tax identification number in the National Provider Directory.

Ownership & related parties

Subparts reporting this organization as parent 17

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

View all 17

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1189468800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1528243200000",
    "number": "1003001173",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3500 CAMP BOWIE BLVD",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761072644",
            "telephone_number": "817-735-2000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "855 MONTGOMERY ST",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "76107",
            "telephone_number": "817-735-2000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "UNIVERSITY OF NORTH TEXAS HEALTH SCIENCE CENTER OF FORT WORTH",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-09-11",
        "last_updated": "2018-06-06",
        "status": "A",
        "authorized_official_last_name": "HENDERSON",
        "authorized_official_first_name": "LESLIE",
        "authorized_official_title_or_position": "REVENUE CYCLE DIRECTOR",
        "authorized_official_telephone_number": "817-735-2008"
    },
    "taxonomies": [
        {
            "code": "207ZP0105X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pathology, Clinical Pathology/Laboratory Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "138980112",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Worth, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 6, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.