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Organization
WEST PARK CLINIC
Active
Organization
WEST PARK CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
NATHAN D HALE MD (PRESIDENT)
(817) 277-4441
Entity
Organization
Contact information
Practice address
1106 W RANDOL MILL RD, ARLINGTON, TX 76012-6506
(817) 277-4441
Mailing address
912 WRIGHT ST, SUITE D, ARLINGTON, TX 76012-4759
(817) 277-4441
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0001GF
BLUE CROSS BLUE SHIELD TX
TX
05
—
082969901
—
TX
01
—
75-1289579
TAX IDENTIFICATION NUMBER
TX
Enumeration date
11/13/2006
Last updated
06/27/2008
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