1275850794 NPI number — GASTROENTEROLOGY ASSOCIATES OF NORTH TEXAS

Table of content: (NPI 1275850794)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275850794 NPI number — GASTROENTEROLOGY ASSOCIATES OF NORTH TEXAS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GASTROENTEROLOGY ASSOCIATES OF NORTH TEXAS
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:
GANT LAB
Provider Other Organization Name Type Code:
5
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:
1275850794
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/23/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6445 HARRIS PKWY
Provider Second Line Business Mailing Address:
STE. 100
Provider Business Mailing Address City Name:
FORT WORTH
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
76132-4138
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
817-361-6900
Provider Business Mailing Address Fax Number:
817-263-5849

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
900 W MAGNOLIA AVE
Provider Second Line Business Practice Location Address:
STE 110
Provider Business Practice Location Address City Name:
FORT WORTH
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76104-8517
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
817-870-7300
Provider Business Practice Location Address Fax Number:
817-332-8372
Provider Enumeration Date:
04/23/2010

Additional Information

Authorized Official

Authorized Official Last Name:
GARDNER
Authorized Official First Name:
GINGER
Authorized Official Middle Name:
Authorized Official Title or Position:
BUSINESS OFFICE
Authorized Official Telephone Number:
817-926-0269

Provider Taxonomy Codes

  • Taxonomy code: 291U00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 45D0860848 . This is a "CLIA" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com