Organization Active NPI

Texas Health Care, P.L.L.C.

  • Ophthalmology Physician
  • Fort Worth, TX
National Provider Identifier
1063720654
Registry record updated Oct 5, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ophthalmology PhysicianTaxonomy code 207W00000X
Legal business name
TEXAS HEALTH CARE, P.L.L.C.
Practice address
4950 Overton Ridge Blvd.
Fort Worth, TX 76132-1909
Phone
(817) 423-2020
Fax
(817) 423-2040
NPI assigned
Sep 17, 2010
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 5, 2010

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

Authorized official

Name
Larry D. Tatum, M.D.
Title
C.E.O.
Phone
(817) 740-8400

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Ophthalmology PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207W00000X Primary

Addresses

Primary practice location

4950 Overton Ridge Blvd.
Fort Worth, TX 76132-1909

Mailing address

P.O. Box 961205
Fort Worth, TX 76116-1205
Phone (817) 740-8400

Other identifiers 1

IdentifierTypeStateIssuer
155109501MedicaidTX

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20031110000388 TX Part B Supplier - Clinic/Group Practice 7214840867 Receives reassigned benefits from 544 practitioners
This NPI is an additional NPI on the enrollment

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1284681600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1286236800000",
    "number": "1063720654",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "P.O. BOX 961205",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761161205",
            "telephone_number": "817-740-8400",
            "fax_number": "817-423-2040"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4950 OVERTON RIDGE BLVD.",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761321909",
            "telephone_number": "817-423-2020",
            "fax_number": "817-423-2040"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TEXAS HEALTH CARE, P.L.L.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-09-17",
        "last_updated": "2010-10-05",
        "status": "A",
        "authorized_official_last_name": "TATUM",
        "authorized_official_first_name": "LARRY",
        "authorized_official_middle_name": "D.",
        "authorized_official_title_or_position": "C.E.O.",
        "authorized_official_telephone_number": "817-740-8400",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Ophthalmology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "155109501",
            "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 Oct 5, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.