| Tackett Custom Medicine | |
|
175 College Park Dr Weatherford TX 76086-6211 | |
| (817) 550-6046 | |
| (817) 550-6047 |
| Full Name | Tackett Custom Medicine |
|---|---|
| Speciality | Clinic/center |
| Location | 175 College Park Dr, Weatherford, Texas |
| Authorized Official Name and Position | David Roger Morris (PIC) |
| Authorized Official Contact | 8174417046 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Tackett Custom Medicine 132 El Chico Trl Willow Park TX 76087-8865 Ph: (817) 441-7046 | Tackett Custom Medicine 175 College Park Dr Weatherford TX 76086-6211 Ph: (817) 550-6046 |
| NPI Number | 1497009583 |
|---|---|
| Provider Enumeration Date | 10/29/2012 |
| Last Update Date | 10/29/2012 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1497009583 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | 28226 (Texas) | Primary |
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