Provider Demographics
NPI:1174947881
Name:THOMAS J TRESE DO, PA
Entity type:Organization
Organization Name:THOMAS J TRESE DO, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:TRESE
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:817-292-7220
Mailing Address - Street 1:5801 OAKBEND TRL
Mailing Address - Street 2:SUITE 175
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76132-3912
Mailing Address - Country:US
Mailing Address - Phone:817-292-7220
Mailing Address - Fax:817-332-6230
Practice Address - Street 1:5801 OAKBEND TRL
Practice Address - Street 2:SUITE 175
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76132-3924
Practice Address - Country:US
Practice Address - Phone:817-292-7220
Practice Address - Fax:817-332-6230
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-17
Last Update Date:2014-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF6142261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX128572801Medicaid
TX354304Medicare PIN