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UT SOUTHWESTERN MONCRIEF CANCER CENTER NPI 1134443765


NPI Information

NPI: 1134443765
Provider Name: UT SOUTHWESTERN MONCRIEF CANCER CENTER

Doing Business As: MONCRIEF CANCER INSTITUTE

Classification: Clinic/Center - 261QM2500X
Entity Type: Organization

Specialization: Medical Specialty

CLIA Number: 45D2095813

Address:
400 W MAGNOLIA AVE
FORT WORTH, TX
ZIP 76104
Phone: (817) 288-9800
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UT SOUTHWESTERN MONCRIEF CANCER CENTER is a medical specialty clinic center in Fort Worth, TX. The provider is an entity, facility, or distinct part of a facility providing diagnostic, treatment, and prescriptive services related to a specific area of medical specialization. Frequently used for Title V related Children's Specialty services or to meet specific public health needs (e.g., infectious diseases or breast and cervical cancer). UT SOUTHWESTERN MONCRIEF CANCER CENTER NPI is 1134443765. The provider is registered as an organization entity type.
The provider Is Doing Business As Moncrief Cancer Institute.

The provider's business location address is:

400 W MAGNOLIA AVE
FORT WORTH, TX
ZIP 76104-617
Phone: (817) 288-9800

The provider's authorized official is Bruce A. Meyer .
The authorized official title is Executive Vice President and has the following contact phone number (214) 645-0624.

The CLIA number assigned to this NPI record is 45D2095813 - other with a certificate type of Certificate of Accreditation.

The enumeration date for this NPI number is 3/25/2010 and was last updated on 7/11/2013.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1261QM2500XClinic/CenterMedical SpecialtyG7980TEXASYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.Other Provider IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
1109397302MEDICAIDTEXAS

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/14/2023

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