Provider Demographics
NPI:1275850794
Name:GASTROENTEROLOGY ASSOCIATES OF NORTH TEXAS
Entity Type:Organization
Organization Name:GASTROENTEROLOGY ASSOCIATES OF NORTH TEXAS
Other - Org Name:GANT LAB
Other - Org Type:Other Name
Authorized Official - Title/Position:BUSINESS OFFICE
Authorized Official - Prefix:MRS
Authorized Official - First Name:GINGER
Authorized Official - Middle Name:
Authorized Official - Last Name:GARDNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-926-0269
Mailing Address - Street 1:6445 HARRIS PKWY
Mailing Address - Street 2:STE. 100
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76132-4138
Mailing Address - Country:US
Mailing Address - Phone:817-361-6900
Mailing Address - Fax:817-263-5849
Practice Address - Street 1:900 W MAGNOLIA AVE
Practice Address - Street 2:STE 110
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-8517
Practice Address - Country:US
Practice Address - Phone:817-870-7300
Practice Address - Fax:817-332-8372
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-23
Last Update Date:2010-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX45D0860848OtherCLIA
TX45D0860848OtherCLIA