# FOSSIL CREEK FAMILY MEDICAL CENTER

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

## Provider details

- **NPI number:** 1639267982
- **Authorized official:** DAVID WAYNE SIMONAK DO (OWNER)
- **Authorized official phone:** (817) 498-1818

## Contact information

- **Practice address:** 7510 N BEACH ST, FORT WORTH, TX 76137
- **Practice address phone:** (817) 498-1818
- **Practice address fax:** (817) 581-3761
- **Mailing address:** 7500 N BEACH ST, FORT WORTH, TX 76137-1505
- **Mailing address phone:** (817) 498-1818
- **Mailing address fax:** (817) 581-3761

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |

## Other

- **Enumeration date:** 10/11/2006
- **Last updated:** 03/15/2019