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Organization

MY1PHP

Active
Parent organization
FOUROAKSHEALTH LLC
Organization subpart
Yes

Provider details

NPI number
Legal business name
FOUROAKSHEALTH LLC
Authorized official
HARRY DONALD SPRING (MANAGING MEMBER)
(817) 875-8031
Entity
Organization

Contact information

Practice address
5131 BRYCE AVE, FORT WORTH, TX 76107-3611
(817) 875-8031
Mailing address
5131 BRYCE AVE, FORT WORTH, TX 76107-3611
(817) 875-8031

Taxonomy

Speciality
Code
Description
License number
State
305S00000X
Point of Service
Primary

Other

Enumeration date
08/02/2016
Last updated
08/02/2016
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  • EDI platform