National Provider Identifier Database

FORT WORTH ENTPA
Specialist

An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree.


Contact Information

FORT WORTH ENT,P.A.
1250 8TH AVE
SUITE 135
FORT WORTH, TX76104
Phone: 817-335-8151
Fax: 817-335-2670
Website:
Specialty Taxonomy Code
* Specialist 174400000X

* Indicates primary specialty

NPI Profile & details for FORT WORTH ENT,P.A.

NPI Number 1336353366
Legal business name
LBN
FORT WORTH ENT,P.A.
Authorized official VICKY VANVLECK - (PRACTICE MANAGER)
Entity Organization
Organization subpart No
Enumeration date 05/09/2007
Last updated 01/24/2011 - About 15 years ago
Sole proprietor1 Not specified
Identifiers
  • TX License #: H2007
  • TX License #: L4150
  • TX Medicaid: 031074002
  • TX Medicaid: 166927701
  • TX Other: H2007 TODD E SAMUELSON MD LICEN
  • TX Other: 8G2131 TODD E. SAMUELSON MD BCBS

1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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