1235180035 NPI number — FORT WORTH DIGESTIVE ASSOCIATES

Table of content: (NPI 1235180035)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235180035 NPI number — FORT WORTH DIGESTIVE ASSOCIATES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FORT WORTH DIGESTIVE ASSOCIATES
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1235180035
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/23/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 470294
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FORT WORTH
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
76147-0294
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
817-885-7888
Provider Business Mailing Address Fax Number:
817-885-7811

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1650 W ROSEDALE ST
Provider Second Line Business Practice Location Address:
SUITE 302
Provider Business Practice Location Address City Name:
FORT WORTH
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76104-7400
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
817-885-7888
Provider Business Practice Location Address Fax Number:
817-885-7811
Provider Enumeration Date:
05/15/2006

Additional Information

Authorized Official

Authorized Official Last Name:
AZIZ
Authorized Official First Name:
SHAHID
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
817-885-7888

Provider Taxonomy Codes

  • Taxonomy code: 207RG0100X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0074MU . This is a "BCBS GROUP NUMBER" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: DD9949 . This is a "MEDICARE RAILROAD" identifier . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com