Organization
FORT WORTH HEART, P.A.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MANDI WOMACK (ADMINISTRATION MNGR)
(817) 338-1300
Entity
Organization
Contact information
Practice address
1900 MISTLETOE BLVD, SUITE 100, FORT WORTH, TX 76104-4014
(817) 338-1300
Mailing address
1900 MISTLETOE BLVD, SUITE 100, FORT WORTH, TX 76104-4014
(817) 338-1300
Taxonomy
Speciality
Code
Description
License number
State
261QM2500X
Medical Specialty Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
084424301
—
TX
01
—
CP2325
MEDICARE RAILROAD GROUP
TX
Enumeration date
02/15/2007
Last updated
06/05/2017
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