| Dewitt Charles Fortenberry, MD | |
|
2602 Saint Michael Dr, Suite 302, Texarkana, TX 75503-2387 | |
| (903) 336-2391 | |
| Not Available |
| Full Name | Dewitt Charles Fortenberry |
|---|---|
| Gender | Male |
| Speciality | Internal Medicine |
| Experience | 36 Years |
| Location | 2602 Saint Michael Dr, Texarkana, Texas |
| Accepts Medicare Assignments | Yes. He accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1114960473 | NPI | - | NPPES |
| 167594401 | Medicaid | TX |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207P00000X | Emergency Medicine | L8691 (Texas) | Secondary |
| 208D00000X | General Practice | L8691 (Texas) | Primary |
| Facility Name | Location | Facility Type |
|---|---|---|
| Christus Homecare - St Michael | Texarkana, TX | Home health agency |
| Christus St Michael Health System | Texarkana, TX | Hospital |
| Willis Knighton Medical Center, Inc | Shreveport, LA | Hospital |
| Specialists Hospital Shreveport | Shreveport, LA | Hospital |
| Christus Mother Frances Hospital | Tyler, TX | Hospital |
| Uams Medical Center | Little rock, AR | Hospital |
| The Villa At Texarkana | Texarkana, TX | Nursing home |
| Entity Name | Medeval, Llc |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1740548346 PECOS PAC ID: 9537319256 Enrollment ID: O20121015000495 |
| Mailing Address | Practice Location Address |
|---|---|
| Dewitt Charles Fortenberry, MD 116 Westlake Rd, Texarkana, TX 75501-0006 Ph: (903) 293-7093 | Dewitt Charles Fortenberry, MD 2602 Saint Michael Dr, Suite 302, Texarkana, TX 75503-2387 Ph: (903) 336-2391 |
Ronald David Rush, MD General Practice Medicare: Not Enrolled in Medicare Practice Location: 5503 N Stateline Ave, Texarkana, TX 75503 Phone: 903-794-7874 Fax: 903-794-0740 |