NPIMap

Organization Active NPI

University of North Texas Health Science Center at Fort Worth

  • Family Medicine Physician
  • Fort Worth, TX
National Provider Identifier
1578686127
Registry record updated Jun 8, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
UNIVERSITY OF NORTH TEXAS HEALTH SCIENCE CENTER AT FORT WORTH
Practice address
3500 Camp Bowie Blvd
Fort Worth, TX 76107
Phone
(817) 735-2000
NPI assigned
Apr 9, 2007
Last updated
Jun 8, 2018By the provider in NPPES
Organization subpart
Yes
Parent organization
UNIVERSITY OF NORTH TEXAS HEALTH SCIENCE CENTER AT FORT WORTHAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jun 8, 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 3

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X
Nurse Practitioner 363L00000X
Family Medicine Physician 207Q00000X Primary

Addresses

Primary practice location

3500 Camp Bowie Blvd
Fort Worth, TX 76107

Mailing address

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

Other identifiers 1

IdentifierTypeStateIssuer
140691001MedicaidTX

National Provider Directory

National Provider Directory
Tax ID family
University North Texas11 organizations share this tax ID, including this one
Part of
University North Texas

Other organizations with this tax ID 10

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

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

NPI Registry JSON

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

{
    "created_epoch": "1176076800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1528416000000",
    "number": "1578686127",
    "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": "3500 CAMP BOWIE BLVD",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "76107",
            "telephone_number": "817-735-2000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "UNIVERSITY OF NORTH TEXAS HEALTH SCIENCE CENTER AT FORT WORTH",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "UNIVERSITY OF NORTH TEXAS HEALTH SCIENCE CENTER AT FORT WORTH",
        "enumeration_date": "2007-04-09",
        "last_updated": "2018-06-08",
        "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": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "140691001",
            "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 8, 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.