Provider Demographics
NPI:1982287942
Name:NASA HEALTHCARE SERVICES LLC
Entity type:Organization
Organization Name:NASA HEALTHCARE SERVICES LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AGNES
Authorized Official - Middle Name:MONGINA
Authorized Official - Last Name:AONDO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-701-7296
Mailing Address - Street 1:6609 MCCART AVE
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76133-5633
Mailing Address - Country:US
Mailing Address - Phone:817-386-7670
Mailing Address - Fax:682-428-7559
Practice Address - Street 1:6609 MCCART AVE
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76133-5633
Practice Address - Country:US
Practice Address - Phone:817-386-7670
Practice Address - Fax:682-428-7559
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-28
Last Update Date:2025-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty