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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 Specialty Code Provider Type

Specialist

174400000X
Indicates primary specialty

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

NPI Number 1336353366
LBN Legal business name FORT WORTH ENT,P.A.
Authorized official VICKY VANVLECK - (PRACTICE MANAGER)
Entity Organization
Organization subpart 1 No
Enumeration date 05/09/2007
Last updated 01/24/2011 - About 15 years ago
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 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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