Provider Demographics
NPI:1073679379
Name:TEXAS HEALTH CARE, P.L.L.C.
Entity type:Organization
Organization Name:TEXAS HEALTH CARE, P.L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:C.E.O.
Authorized Official - Prefix:
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:D
Authorized Official - Last Name:TATUM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:817-740-8400
Mailing Address - Street 1:P.O. BOX 961205
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76161-1205
Mailing Address - Country:US
Mailing Address - Phone:817-740-8400
Mailing Address - Fax:817-378-3699
Practice Address - Street 1:134 EL CHICO TRAIL
Practice Address - Street 2:SUITE 103
Practice Address - City:WILLOW PARK
Practice Address - State:TX
Practice Address - Zip Code:76087-8862
Practice Address - Country:US
Practice Address - Phone:817-740-8400
Practice Address - Fax:817-900-6265
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-29
Last Update Date:2024-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
No204C00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine, Sports MedicineGroup - Multi-Specialty
No207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Multi-Specialty
No207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Multi-Specialty
No2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Multi-Specialty
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Multi-Specialty
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX154920601Medicaid
CK8412OtherRAILROAD MEDICARE
TX154920602Medicaid
TX45D0900920OtherCLIA
TX154920603Medicaid
CK8411OtherRAILROAD MEDICARE
TX45D0900920OtherCLIA
CK8412OtherRAILROAD MEDICARE