# CARDIOLOGY AND ELECTROPHYSIOLOGY CLINIC FORT WORTH PC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1215704291
- **Authorized official:** TAMEKA MIDDLEBROOKS (CREDENTIALING)
- **Authorized official phone:** (682) 239-9532

## Contact information

- **Practice address:** 1001 12TH AVE STE 134, FORT WORTH, TX 76104-3927
- **Practice address phone:** (817) 368-6480
- **Mailing address:** 1001 12TH AVE STE 134, FORT WORTH, TX 76104-3927

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207RC0000X | Cardiovascular Disease Physician | — | NULL | — |
| 207RC0000X | Cardiovascular Disease Physician | — | — | — |
| 207RC0001X | Clinical Cardiac Electrophysiology Physician | — | NULL | Yes |
| 207RC0001X | Clinical Cardiac Electrophysiology Physician | — | — | Yes |

## Other

- **Enumeration date:** 12/08/2023
- **Last updated:** 12/08/2023