Organization
TEXAS HEALTH CARE, P.L.L.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LARRY D. TATUM M.D. (C.E.O.)
(817) 740-8400
Entity
Organization
Contact information
Practice address
800 W MAGNOLIA AVE STE 100, FORT WORTH, TX 76104-4611
(817) 882-1193
(817) 870-1602
Mailing address
P. O. BOX 961205, FORT WORTH, TX 76161-1205
(817) 740-8400
(817) 378-3699
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00406U
MEDICARE GROUP
TX
01
—
155109501
MEDICAID GROUP
TX
Enumeration date
03/07/2007
Last updated
09/21/2009
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