Update this page – If you believe information in your NPPES record is inaccurate, or if you wish to update or deactivate your NPI, you can do so directly with CMS.
Organization
FORT WORTH PEDIATRICS
Active
Organization
FORT WORTH PEDIATRICS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DIANE A RICHEY (BUSINESS ADMINISTRATOR)
(817) 336-4040
Entity
Organization
Contact information
Practice address
5708 EDWARDS RANCH ROAD, FORT WORTH, TX 76109
(817) 336-4040
(817) 336-6780
Mailing address
5708 EDWARDS RANCH ROAD, FORT WORTH, TX 76109
(817) 336-4040
(817) 336-6780
Taxonomy
Speciality
Code
Description
License number
State
2080A0000X
Pediatric Adolescent Medicine Physician
Primary
—
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00L72L
BCBS
TX
01
—
10001409
AMERIGROUP
TX
05
—
130900702
—
TX
05
—
130900703
—
TX
05
—
130900704
—
TX
01
—
8541908
AETNA
TX
Enumeration date
05/16/2006
Last updated
06/13/2011
About Stedi
Stedi is the only programmable healthcare clearinghouse. You can use Stedi's APIs to process eligibility checks, claims, remits, and more.
Sign up