Organization
TEXAS CENTERS FOR INFECTIOUS DISEASE ASSOCIATES PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CHERYL KAY MCDONALD MD (PROVIDER)
(817) 810-9810
Entity
Organization
Contact information
Practice address
1025 COLLEGE AVE, FORT WORTH, TX 76104-3013
(817) 810-9811
(817) 810-9815
Mailing address
1025 COLLEGE AVE, FORT WORTH, TX 76104-3013
(817) 810-9810
Taxonomy
Speciality
Code
Description
License number
State
207RI0200X
Infectious Disease Physician
Primary
—
—
3336C0003X
Community/Retail Pharmacy
—
—
3336H0001X
Home Infusion Therapy Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00099K
BCBS GROUP
TX
05
—
079871202
—
TX
01
—
CH8204
MEDICARE RR GROUP
—
Enumeration date
05/15/2006
Last updated
01/04/2024
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