Organization Active NPI

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

  • Internal Medicine Physician
  • Fort Worth, TX
National Provider Identifier
1669539151
Registry record updated Oct 15, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
TEXAS HEALTH CARE, P.L.L.C.
Practice address
6100 Harris Parkway,
Suite 355
Fort Worth, TX 76132-4134
Phone
(817) 433-5488
Fax
(817) 433-5100
NPI assigned
Jan 3, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 15, 2011

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
Internal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207R00000X Primary

Addresses

Primary practice location

6100 Harris Parkway,
Suite 355
Fort Worth, TX 76132-4134

Mailing address

P.O. Box 961205
Fort Worth, TX 76161-1205
Phone (817) 740-8400

Other identifiers 2

IdentifierTypeStateIssuer
45D0678652OtherTXCLIA
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

Locations

6100 Harris Pkwy
Ste 355
Ft Worth, TX 76132
Phone (817) 433-5488

NPI Registry JSON

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

{
    "created_epoch": "1167782400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1318636800000",
    "number": "1669539151",
    "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": "6100 HARRIS PARKWAY,",
            "address_2": "SUITE 355",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761324134",
            "telephone_number": "817-433-5488",
            "fax_number": "817-433-5100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TEXAS HEALTH CARE, P.L.L.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-03",
        "last_updated": "2011-10-15",
        "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": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CLIA",
            "identifier": "45D0678652",
            "state": "TX"
        },
        {
            "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 15, 2011; 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.