Active NPI
Texas Health Care, P.L.L.C.
- Colon & Rectal Surgery Physician
- Fort Worth, TX
National Provider Identifier
1174847370
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Colon & Rectal Surgery Physician
- Legal business name
- TEXAS HEALTH CARE, P.L.L.C.
- Practice address
- 1325 Pennsylvania Ave Ste 400
Fort Worth, TX 76104-2128 - Phone
- (817) 250-5900
- Fax
- (817) 250-5901
- NPI assigned
- Mar 17, 2010
- Organization subpart
- No
NPPES NPI Registry
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) | Code | License | State | Primary |
|---|---|---|---|---|
| Colon & Rectal Surgery Physician | 208C00000X | Primary |
Addresses
Primary practice location
1325 Pennsylvania Ave Ste 400
Fort Worth, TX 76104-2128
Mailing address
P.O. Box 961205
Fort Worth, TX 76161-1205
Phone (817) 740-8400
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 155109501 | Medicaid | TX | |
| 45D0485973 | Other | CLIA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in TX
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| 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 DirectoryNPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1268784000000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1268784000000",
"number": "1174847370",
"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": "761611205",
"telephone_number": "817-740-8400",
"fax_number": "817-378-3699"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1325 PENNSYLVANIA AVE STE 400",
"city": "FORT WORTH",
"state": "TX",
"postal_code": "761042128",
"telephone_number": "817-250-5900",
"fax_number": "817-250-5901"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "TEXAS HEALTH CARE, P.L.L.C.",
"organizational_subpart": "NO",
"enumeration_date": "2010-03-17",
"last_updated": "2010-03-17",
"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": "208C00000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Colon & Rectal Surgery",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "155109501",
"state": "TX"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CLIA",
"identifier": "45D0485973",
"state": null
}
],
"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 Mar 17, 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.