Provider Demographics
NPI:1346306701
Name:TEXAS HEALTH CARE PLLC
Entity type:Organization
Organization Name:TEXAS HEALTH CARE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
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 1:508 S ADAMS ST STE 100
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-2151
Practice Address - Country:US
Practice Address - Phone:817-332-5099
Practice Address - Fax:817-332-9093
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-29
Last Update Date:2015-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX155109501Medicaid
TX45D0969321OtherCLIA
TX45D0969321OtherCLIA
TX45D0969321OtherCLIA