Organization
MARY M CARTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARY M CARTER (LSA)
(817) 294-7444
Entity
Organization
Contact information
Practice address
1301 PENNSYLVANIA AVE, FORT WORTH, TX 76104-2122
(817) 882-2000
Mailing address
PO BOX 11219, FORT WORTH, TX 76110-0219
(817) 294-7444
Taxonomy
Speciality
Code
Description
License number
State
246ZS0410X
Surgical Technologist
Primary
SA00165
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0005LF
BCBS
TX
Enumeration date
10/25/2006
Last updated
08/22/2020
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